77 - Penetrating Neck Trauma

• Bruit or thrill suggestive of a traumatic arteriovenous fistula • Expanding or pulsatile hematoma • Pulsatile or severe hemorrhage • Pulse deficit—pulses may be normal in patients with nonocclusive injuries that require surgical repair, such as intimal flaps or pseudoaneurysms • Thorough vascular and esophageal evaluation is required, even with minor neck wounds, if any abnormalities are evident on examination or radiographs. • Radiographs do not rule out esophageal injury. • Early airway management is crucial, with orotracheal intubation being the initial method of choice. • A thorough neurologic examination is essential in all patients with neck trauma. • “Hard signs” of vascular injury include bruit, thrill, expanding or pulsatile hematoma, pulsatile or severe hemorrhage, pulse deficit, and central nervous system ischemia. • The “gold standard” for diagnosing vascular injury is conventional angiography. • Admission criteria include signs and symptoms of organ damage and penetration of the platysma muscles. KEY POINTS