Lecture Summary

Penetrating neck trauma -- the serious, severe variety -- poses a huge challenge to any ED or trauma team. The need to co-manage airway AND breathing, using techniques not often employed in other circumstances, demands a streamlined approach to teamwork and taskwork. A modified primary survey focused on hard findings of vascular injury is key: if present, your patient is 90% likely to need operative intervention for their injury, will require massive resuscitation and definitive airway control early on. The NO ZONE approach veers away from defining injuries based on neck zone anatomy, particularly now that mandatory surgical exploration for platysma-violating Zone II injuries has been replaced with multi-detector CTA. What are your favorite tips and tricks for direct hemorrhage control with penetrating neck injuries? How do you apply direct pressure? Do you use a foley, or more than one foley, for deep wounds? As for airway: the Double Double refers to video laryngoscopy to guide video bronchoscopy (the first Double) with a double setup for front-of-neck access if that approach fails. How comfortable are you with this technique? RSI or no RSI? If awake, how do you optimize first pass success? And sometimes your best option is to forgo laryngoscopy altogether: with distorted anatomy (hematoma, tracheal injury) your best bet is probably front of neck access. What technique are you most comfortable with? Finger-bougie-cric? Or something else?

Target Audience

Emergency Medicine Doctors
Emergency Medicine Nurses
Paramedics
Rural GP's

Learning Objectives:

Upon completion of this activity, you should be able to:

• Define the key priorities in the management of neck injuries
• Describe the hard and soft findings in neck injury assessment
• Appreciate the double-double airway approach

None.