The EM Educator Series: “I either got stabbed or shot in my neck”

Author: Alex Koyfman, MD (@EMHighAK) // Edited by: Brit Long, MD (@long_brit) and Manpreet Singh, MD (@MprizzleER)

Welcome back to the EM Educator Series. These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation and management of the specific condition discussed.

This week has another downloadable PDF document with questions, links and answers you can share with learners as educators in #MedEd. Please message us over Twitter and let us know if you have any feedback on ways to improve this for you. Enjoy!

Case:

An 18-year-old male is brought in by EMS after assault. He was stabbed to the neck, and EMS immediately placed pressure over the wound. He is tachycardic and hypotensive on arrival.

Considerations:

• What are the zones of the neck and key structures contained within these zones? Are these zones still pertinent for ED evaluation and management? What other injuries outside of neck should you consider?
• What should you consider for airway management? RSI? Direct vs video vs fiberoptic vs cricothyrotomy?
• What vascular injuries can occur, and what hard and soft signs?
• Is a C-collar needed in penetrating trauma?
• What laryngotracheal injuries do you need to consider?
• What about pneumo- and/or hemothorax? What does subcutaneous emphysema suggest?
• How do esophageal injuries present?
• What diagnostic modalities can assist? What about CTA, endoscopy or esophagram, or bronchoscopy?

From Dr. Katy Hanson at Hanson’s Anatomy:

Suggested Resources: 

• Articles:
  • REBEL EM – Penetrating Neck Injuries
  • net – Neck Trauma: A Practice Update
  • net – The Sphincter Series: A Scary Airway Review
  • EM in 5 – Penetrating Neck Trauma
  • Management of Major Vascular Injuries: Neck, Extremities, and Other Things that Bleed.
  • Evaluation and management of neck trauma.
  • Management of penetrating neck injury in the emergency department: a structured literature review.
• Podcasts:
  • CORE EM – Episode 152.0 – Penetrating Neck Trauma