Neck Trauma

Question 1

Match: inspiratory and expiratory stridor, with supraglottic and subglottic?

Answer 1

• Supraglottic = inspiratory

- Subglottic = expiratory

Question 2

Pts with a c-spine fracture should always be assessed for what other injury?

Answer 2

noncontiguous vertebral fracture

Question 3

What are the nexus criteria? (5)

Answer 3

• Alert, not intoxicated
• No neck pain
• No Midline TTP
• No distracting injury
• No sensory/motor complaints

Question 4

What are zones I-III of the neck?

Answer 4

I = below cricoid cartilage
II = from abvoe to angle of the mandible
III = Above angle of the mandible

Question 5

What is the appropriate diagnostic workup for penetrating trauma to each of the three zones of the neck?

Answer 5

I = Angiography, EGD
II = explore, observe, CTA
III = Angiography

Question 6

Which zone of the neck has the highest mortality associated with it?

Answer 6

Zone 1

Question 7

What are the three major functions of the larynx that need to be assessed with neck trauma?

Answer 7

Speech
Airway
Swallowing

Question 8

What are some s/sx that a patient has laryngeal trauma?

Answer 8

• muffled voice
• stridor
• Drooling
• SQ air
• hematoma
• cartilaginous step off

Question 9

What are the labs that may be helpful in the trauma pt? (4)

Answer 9

• CBC
• BMP
• PT/INR
• ABG

Question 10

What is the best diagnostic tool to assess the larynx for injury?

Answer 10

CT angio

Question 11

If the platysma has been penetrated, what basic imaging should be performed?

Answer 11

CXR

Question 12

When is a cervical CT indicated for neck trauma?

Answer 12

Nexus criteria not met

Question 13

What are s/sx of vascular injuries to the neck?

Answer 13

pulse deficit
GI blood
SQ air
Hoarseness

Question 14

What is the diagnostic test for vascular injuries to the neck?

Answer 14

Angiography

Question 15

Why are LMAs contraindicated in the treatment of neck trauma?

Answer 15

May just blow air through laryngeal defects

Question 16

True or false: if the platysma is violated, you should probe the ensure major structures are not violated

Answer 16

False

Question 17

Where should foreign bodies be removed at (ED or OR)?

Answer 17

OR

Question 18

If intubation fails in a neck trauma, what is the next step to secure an airway?

Answer 18

Cricothyroidotomy

Question 19

What is the disposition for all patients with known laryngotracheal injury?

Answer 19

at least obs for 24-48 hours

Question 20

When can a backboard be removed in a patient with a known cervical spine injury?

Answer 20

Once in facility with definitive care

Question 21

Cervical spinal injuries above what level may cause respiratory compromise?

Answer 21

C6

Question 22

What must be done in patients who are intoxicated or altered with possible spinal cord trauma?

Answer 22

Frequent reassessments