Emergency Medicine

NECK INJURIES

Surgical Emergencies 229

(ii) Infuse methylprednisolone 30 mg/kg over 15 min, followed

45 min later by 5.4 mg/kg per hour for 23 h.

Airway injury

DIAGNOSIS

1 Airway injuries may be penetrating or blunt, isolated, or associated with
multiple injuries.

2 Patients may present with a hoarse voice, pain, stridor, cough and/or
haemoptysis.

3 Examine for local swelling, subcutaneous emphysema, pneumothorax or
haemothorax.

4 Perform anteroposterior and lateral cervical spine X-rays and a CXR.

MANAGEMENT

1 Do not leave the patient unattended at any stage. Call for urgent senior ED
staff to help.

2 Perform endotracheal intubation or cricothyrotomy, or insert an endo-
tracheal tube directly into a gaping wound in the trachea to maintain patency
of the airway.

3 Refer the patient immediately to the surgical team for admission.
(i) Arrange a CT scan once the airway has been protected by an
endotracheal tube.

Vascular injury in the neck

DIAGNOSIS AND MANAGEMENT

1 Vascular injury causes obvious external haemorrhage, or internal bleeding
with rapid haematoma formation, which may compromise the airway.

2 Do not attempt to probe or explore any penetrating wounds in the ED. Leave
all penetrating objects in situ.

3 The patient will require angiography and panendoscopy with urgent surgi-
cal referral to arrange formal wound exploration in theatre.

Nerve injury in the neck

DIAGNOSIS AND MANAGEMENT

1 Damage to the following nerves causes specific signs and symptoms:
(i) Recurrent laryngeal branch of the vagus: hoarseness and vocal
cord paralysis.
(ii) Accessory nerve: loss of function of trapezius and sternomastoid.
(iii) Phrenic nerve: loss of diaphragmatic movement.