Penetrating neck injury | Right Decisions

Right Decisions
North of Scotland major trauma guidelines
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General/vascular/urology
Penetrating neck injury

Update your RDS mobile app to v4.7.2 to download toolkits even when website is down.

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. You will see that each toolkit has a small QR code icon in the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively update to the latest release - RDS app version 4.7.1 - to see this improvement.

Updating to this latest version of the RDS app is also strongly recommended to get the full benefits of the new resilience arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Anatomical zones of the neck

Diagram showing zones 1, 2 and 3 of the neck. — Image credit: NECK TRAUMA Rosen Emergency Medicine 10th Edition (Chapter 36)

Management principles

Consider a definitive airway early in penetrating neck injuries

If the platysma is not breached, a significant injury is effectively excluded.
If this distinction cannot be made, then further investigation is required.
Ensure early airway assessment and consider a definitive airway early where appropriate.

Access for hard and soft signs

Hard signs	Soft signs
Active haemorrhage Pulsatile / expanding haematoma Bruit/thrill Haemodynamic instability Unilateral upper limb pulse deficit Massive haemoptysis / haematemesis Air bubbling in the wound Airway compromise Cerebral Ischemia Major Haemorrhage Apply direct pressure Consider haemostatic dressings Foley catheter	Non pulsatile / non-expanding haematoma Venous oozing Dysphagia Dysphonia Subcutaneous emphysema

Imaging vs. theatre

Unstable patients with hard signs require emergency surgery.
Perform immediate CTA Neck in patients with hard signs not requiring emergency surgery.
Perform immediate CTA Neck in patients with soft signs.

Other injuries to consider

If there is concern for aerodigestive injury despite normal / equivocal CTA:

Consider Barium Swallow in conjunction with laryngoscopy / esophagoscopy.
Consider ENT and cardiothoracic involvement as required. Some Zone 1 injuries will require a thoracotomy for proximal control.