Assess for signs/symptoms of vascular injury - high risk mechanisms are often associated with polytrauma - if concerns discuss with radiology / vascular surgeons the utility of CT angiogram of neck.
Dyspnoea, dysphonia and stridor are red flags. AcuteĪssess for signs/symptoms of aero-digestive injury - presence of any warrants discussion with ENT for consideration of flexible fibreoptic laryngoscopy. Pulmonary inflammation if aspirated so it is better avoided if there is an aspiration risk.Īll patients with signs / symptoms of injury to the neck should beĭiscussed with ENT for consideration of fibreoptic laryngoscopy.
Barium contrast can cause mediastinal and/or.
Water soluble contrast, if swallowed prior to x-ray may.
Study, but this investigation should not be ordered without ENT without contrast, may be better able to identify laryngealįracture, but should not be performed in the unstable patient
Severe facial fracture (LeForte II or III only)ĬT neck, i.e.
Base of skull fracture - in particular a fracture extending through the petrous temporal bone and involving the carotid canal.
GCS <8 without significant CT head findings.
Lateralising neurologic deficit (not explained by CT head).
X-rays of neck (soft tissue views) - May show surgicalĮmphysema and soft tissue swelling, but are unreliable in demonstratingĪngiogram of neck - Evidence the role of CTĪngiogram of the neck to screen for associated cerebrovascular injury toĬarotid and/or vertebral arteries is limited in the paediatric population.Īngiogram of neck in blunt trauma include: Pneumomediastinum / pleural effusion / hydrothorax / subcutaneousĮmphysema in the event of oesophageal perforation Minor signs should still lead to very careful observation. Patient with an apparently stable airway, in the first few hours, may
abnormal neurological examination of limbs.
Unrestrained passenger hitting neck onto dashboard With sash of seatbelt lying across the neck
rapid deceleration of restrained passenger, especially.
(garrotting) type injury in either setting Striking neck onto the edge of a low tableįrom bicycles and striking neck on the handle-bars With resultant stroke, neurological injury to the brachial plexus or Neck can lead to laryngeal injury and airway compromise, vascular injury Nature of the injury, and the regions of the body injured can be difficultĪs the injury may be unwitnessed or “hidden” within the multi-trauma History – any direct blow/trauma to the neck or
Initial assessment following an ATLS protocol.ĭuring the assessment of the neck, consider the four types of vital With neck trauma have commonly been involved in a multi-system trauma requiring To non-accidental injury (strangulation) or hanging. Blunt injuries to the neck may also occur due Motorcyclists (clothes-line or garrotting type injuries). Secondary to motor vehicle accidents, especially if unrestrained, or Injuries after falls onto objects in their environment (e.g. Wounds, stab wounds, or debris, such as glass or shrapnel, secondary toĮxperimentation with flammable/explosive materials. Penetrating neck injuries in the older child may include those from gunshot Neck trauma may be blunt, penetrating or a combination of both. Number of vital structures, that if injured can rapidly lead to a loss of life. Short necks, and the relative protection afforded by the mandible and cervical Traumatic neck injuries are rare in children due to their comparatively Immediate assistance from anaesthetic and ENT Require intubation should be considered to have a difficult airway. Even minor signs should still lead to very Airway, in the first few hours, may deteriorate quickly due to oedema.
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