Management of neck injury

This section will deal primarily with penetrating neck trauma. Blunt trauma causing spinal injury is included in the section on the spine. All forms and causes of airway obstruction are covered in section 5.1.

The ability to recognize platysmal penetration is deemed essential at all hospital levels. This implies the ability to recognize the physical finding, understand its significance and either treat the patient accordingly or refer to the next level of the health care system. Such skills are desirable for the basic level, especially in areas with high rates of penetrating trauma.

The ability to perform external control of haemorrhage is essential at all levels of the health care system. More advanced initial manoeuvres include packing and balloon catheter tamponade. These are deemed desirable at all levels of the health care system. All of these imply the requisite skills in airway management (section 5.1), especially as compression of neck wounds may exacerbate airway compromise. Such packing, with or without balloon tamponade, implies a level of skill that would not be expected, and hence would be Irrelevant, at most basic units. However, it might be useful even at basic facilities in areas with high levels of penetrating trauma.

TABLE 5 Neck injury

Facility level

Resources

Basic

GP

Specialist

Tertiary

Recognize platysmal penetration

D

E

E

E

External pressure for bleeding

E

E

E

E

Packing, balloon tamponade for bleeding

D

D

D

D

Contrast radiography, endoscopy

I

I

D

E

Angiography

I

I

D

D

Surgical skills to explore neck

I

PR

E

E

Ancillary diagnostic tests include contrast radiography (oesophagography), endoscopy (laryngoscopy, bronchoscopy) and angiography. The high cost of the latter prevents it from being considered essential.

Surgical exploration of penetrating neck trauma is the definitive diagnostic test and the definitive mode of treatment. It is deemed essential at specialist and tertiary hospitals. In more remote, rural low-income areas, it is possibly required at GP hospitals, primarily in those locations where facilities for referral are limited. In such cases, appropriate training in exploration, repair of oesophageal injuries and primary suturing of vascular injuries should be assured for any GP expected to undertake such work.

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