12 Min.

Episode 173.0 – Blunt Neck Trauma Core EM - Emergency Medicine Podcast

    • Medizin

We go into one of the more complex injuries – blunt neck trauma.

Hosts:

Audrey Bree Tse, MD

Brian Gilberti, MD







https://media.blubrry.com/coreem/content.blubrry.com/coreem/Blunt_Neck_Injuries.mp3







Download





One Comment











Tags: Trauma











Show Notes

Overview



Blunt neck trauma comprises 5% of all neck trauma

Mortality due to loss of airway more so than hemorrhage



Mechanism



MVCs with cervical hyperextension, flexion, rotation during rapid deceleration, direct impact  

Strangulation: hanging, choking, clothesline injury (see section on strangulation in this chapter)

Direct blows: assault, sports, falls



Initial Management/Primary Survey



Airway



Evaluate for airway distress (stridor, hoarseness, dysphonia, dyspnea) or impending airway compromise

Early aggressive airway control: low threshold for intubation if unconscious patient, evidence of airway compromise including voice change, dyspnea, neurological changes, or pulmonary edema

Assume a difficult airway 





* Breathing





Supplemental oxygen

Assess for bilateral breath sounds 

Can use bedside US to evaluate for pneumothorax or hemothorax





* Circulation





Assess for open wounds, bleeding, hemorrhage 

IV access





* Disability





Maintain C-spine immobilization 

Calculate GCS

Look for seatbelt sign







Secondary Survey



Evaluate for specific signs of vascular, laryngotracheal, pharyngoesophageal, and cervical spinal injuries with inspection, palpation, and auscultation

Perform extremely thorough exam to evaluate for any concomitant injuries (e.g. stab wounds, gunshot wounds, intoxications/ ingestions, etc.)



Types of Injuries



Vascular injury









Overview

















Carotid arteries (internal, external, common carotid) and vertebral arteries injured

Mortality rate ~60% for symptomatic blunt cerebral vascular injury





Mechanism



Hyperextension and lateral rotation of the neck, direct blunt force, strangulation, seat belt injuries, and chiropractic manipulation

Morbidity due to intimal dissections, thromboses, pseudoaneurysms, fistulas, and transections





Clinical Features



Most patients are asymptomatic and do not develop focal neurological deficits for days

if Horner’s syndrome, suspect disruption of thoracic sympathetic chain (wraps around carotid artery)

specific screening criteria are used to detect blunt cerebrovascular injury in asymptomatic patients (see below)













Tintinalli 2016



Diagnostic Testing



Gold standard for blunt cerebral vascular injury = MDCTA (multidetector four-vessel CT angiography)

We go into one of the more complex injuries – blunt neck trauma.

Hosts:

Audrey Bree Tse, MD

Brian Gilberti, MD







https://media.blubrry.com/coreem/content.blubrry.com/coreem/Blunt_Neck_Injuries.mp3







Download





One Comment











Tags: Trauma











Show Notes

Overview



Blunt neck trauma comprises 5% of all neck trauma

Mortality due to loss of airway more so than hemorrhage



Mechanism



MVCs with cervical hyperextension, flexion, rotation during rapid deceleration, direct impact  

Strangulation: hanging, choking, clothesline injury (see section on strangulation in this chapter)

Direct blows: assault, sports, falls



Initial Management/Primary Survey



Airway



Evaluate for airway distress (stridor, hoarseness, dysphonia, dyspnea) or impending airway compromise

Early aggressive airway control: low threshold for intubation if unconscious patient, evidence of airway compromise including voice change, dyspnea, neurological changes, or pulmonary edema

Assume a difficult airway 





* Breathing





Supplemental oxygen

Assess for bilateral breath sounds 

Can use bedside US to evaluate for pneumothorax or hemothorax





* Circulation





Assess for open wounds, bleeding, hemorrhage 

IV access





* Disability





Maintain C-spine immobilization 

Calculate GCS

Look for seatbelt sign







Secondary Survey



Evaluate for specific signs of vascular, laryngotracheal, pharyngoesophageal, and cervical spinal injuries with inspection, palpation, and auscultation

Perform extremely thorough exam to evaluate for any concomitant injuries (e.g. stab wounds, gunshot wounds, intoxications/ ingestions, etc.)



Types of Injuries



Vascular injury









Overview

















Carotid arteries (internal, external, common carotid) and vertebral arteries injured

Mortality rate ~60% for symptomatic blunt cerebral vascular injury





Mechanism



Hyperextension and lateral rotation of the neck, direct blunt force, strangulation, seat belt injuries, and chiropractic manipulation

Morbidity due to intimal dissections, thromboses, pseudoaneurysms, fistulas, and transections





Clinical Features



Most patients are asymptomatic and do not develop focal neurological deficits for days

if Horner’s syndrome, suspect disruption of thoracic sympathetic chain (wraps around carotid artery)

specific screening criteria are used to detect blunt cerebrovascular injury in asymptomatic patients (see below)













Tintinalli 2016



Diagnostic Testing



Gold standard for blunt cerebral vascular injury = MDCTA (multidetector four-vessel CT angiography)

12 Min.