Neck Injuries
224 Surgical Emergencies
4 Nose
(i) Examine for evidence of blood or cerebrospinal fluid (CSF)
leakage suggesting a basal skull fracture (see p. 31).
(ii) Palpate for deformity and nasal bone fracture (see p. 401).
(iii) Look specifically for a septal haematoma, which, if large, will
require incision and drainage to reduce the risk of subsequent
cartilage necrosis (see p. 401).
5 Mouth
(i) Examine for broken or missing teeth. They may have been
inhaled (see p. 429).
(ii) Check for dental malocclusion, suggesting maxillary or
mandibular fracture (see p. 430).
(iii) Assess for nasopharyngeal bleeding, which may be profuse
and associated with a basal skull fracture. Look for any tongue
lacerations, although they rarely need repairing (see p. 428).
6 Ears
(i) Examine for skin and cartilage damage, which will require
drainage and suture later.
(ii) Consider perforation of the eardrum, although if frank bleeding
is seen, do not examine with a speculum to avoid introducing
infection:
(a) this bleeding may be associated with either a basal skull
fracture or damage to the external ear canal (see p. 397).NECK INJURIES
Cervical spine injury
This should be considered in all patients with localized neck pain or pain on
palpation following trauma. It should also be assumed in any unconscious head
injury, multiply injured patient, a patient under the inf luence of alcohol or drugs,
and a patient with a locally distracting injury above the clavicles.DIAGNOSIS
1 Ask about local pain or tenderness on palpation if the patient is conscious,
and about any associated limb weakness or sensory deficit noticed.
2 Check the vital signs. A cervical or high thoracic cord lesion will cause respi-
ratory difficulty, tachypnoea and abdominal breathing.
(i) Loss of sympathetic tone will cause bradycardia, hypotension
and hypothermia from vasodilation if the ambient temperature
is low.