In trauma to the neck which indicates immediate management
Correct Answer: Stridor
Description: 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
Category:
Surgery
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