SAQ 449 – Trauma – penetrating zone 1 neck injury

Trauma – penetrating zone 1 neck injury.

a. Photograph description

• Penetrating wound at the base of the neck/supraclavicular region.
• Contaminated wound with soil/wood debris.
• Surrounding abrasion, bruising and erythema.
• Platysma violation is possible from the depth/location.
• No active external haemorrhage is visible.

b. Zone

• Zone 1 of the neck.

c. At-risk structures

• Common carotid artery.
• Internal jugular vein.
• Subclavian vessels.
• Trachea.
• Oesophagus.
• Apex of lung/pleura.
• Brachial plexus or recurrent laryngeal nerve if clinically relevant.

d. Imaging

• CT angiography of the neck/chest, or CT with IV contrast; non-contrast CT alone is insufficient.

e. Management

• Assess and protect airway early, with senior airway/anaesthetic help if any compromise or expanding haematoma.
• Assess circulation, control external bleeding and obtain IV access/bloods/crossmatch.
• Give titrated analgesia with a clear endpoint.
• Give tetanus prophylaxis and antibiotics appropriate for a contaminated penetrating wound.
• Urgent surgical/ENT/vascular consultation and admit for definitive management.