In trauma to the neck which indicates immediate management

Trauma to neck Immediate Management Neck injuries can often require rapid intervention because of the vulnerability of the contained vital structures. The highest priority concern is establishment of a secure airway, especially given the rapidity with which deterioration can occur in the setting of a neck injury. Direct injury to the larynx or trachea is the most common cause of airway compromise. Expanding neck hemato- mas can quickly compress the upper airway, leading to inadequate ventilation. Immediate intubation should occur in the setting of an expanding neck hematoma or if there is concern about impend- ing airway compromise. Suspected laryngotracheal injury presents one of the most challenging airway management situations. Patients who are maintaining their own airway should have a planned approach to airway management that might include intu- bation or awake tracheostomy in the operating room. Attempted intubation could worsen a tenuous situation and should not be performed without a well-developed backup plan. A loss of airway requires emergent intervention that might include performing a surgical airway. The surgical airway of choice for an upper airway injury is a tracheostomy because injury to the larynx could make cricothyroidotomy ineffective. In the immediate setting, hemorrhage is the other major concern that might occur after neck injury. Direct pressure effec- tively manages most bleeding from the neck, at least during transpo to the operating room and initiation of neck explora- tion. Injury to the large vessels of the neck will often require control in the operating room. Bleeding should be immediately treated with digital pressure on the wound until operative expo- sure can be achieved. Large quantities of blood can be lost quickly, so resuscitation with blood products should be rapidly initiated. Patients with suspected injury should be rapidly trans- ferred to the operating room for surgical management of ongoing bleeding. Ref: Sabiston 20th edition Pgno :423