Timing of intervention may influence outcomes in blunt injury. Any symptoms or neurological deficits following blunt neck injury mandate evaluation and consideration of bcvi. Blunt aortic injury, evaluation and management of 2015. Thyroid gland rupture caused by blunt trauma to the neck.
Assaults, sports related injuries and clotheslinetype injuries are also common. Blunt injury definition of blunt injury by medical dictionary. Blunt cerebrovascular injury practice management guideline. Phrenic nerve injury following blunt trauma emergency. A traumatic injury caused by the application of mechanical force to the body by a blunt force, object or instrumente. Oct 07, 2019 multisection ct and ct angiography are commonly performed to assess these injuries in the emergency department. Jul 12, 2017 when neck trauma results from a motor vehicle crash, inquire about seat belt use, location of the patient in the car driver or front or back seat passenger, deployment of an air bag, and magnitude of car damage eg, intrusion, steering column and windshield intact or broken.
Blunt injury to the neck is most commonly from motor vehicle collisions, sport and falls 1,2. The incidence of bci relative to blunt neck injury bni was evaluated over the course of the study. Arteries and veins carry this blood to and from the heart and carry oxygen to all parts of the body. The majority of injuries are penetrating, with blunt trauma accounting for only 5% of neck trauma cases. Blunt carotid injury can present either with coma or without neurologic finding. Vascular assessment using cta should be obtained even in blunt trauma, as there is a high miss rate of vascular injuries in blunt neck trauma with delayed neurologic sequelae as a result. In this type of injury, there is damage to blood vessels as they are torn or cut by piercing or crushing injuries, such as. Factors associated with cervical spine injury in children.
Evaluation and management of neck trauma request pdf. Blunt neck trauma sever blunt neck trauma can result in significant laryngeal and vascular injury best modality in stable pt contrast enhance ct to demonstrate the injury and aid for further invasive investigation or exploration 35 dr. Blunt trauma accounts for the smallest number of neck injuries. Pah neck injury module revised 2016 neck trauma introduction traumatic neck injuries can be lifethreatening, with potential for aerodigestive or vascular injury. In an effort to highlight this issue, we report the case of a 31yearold male patient who presented with leftsided weakness consistent with. Jan 09, 2018 penetrating injury to the neck mostly gives rise to cervical vascular injuries. Imaging and management of blunt cerebrovascular injury. Strangulation may be either manual or ligature due to hands or a device compressing the. Prehospital and emergency assessment and management will therefore always prove challenging, as individual exposure to this.
Firm manual compression over the wound reduces the air. Peitzman, ab, rhodes, m, schwab, cw, yealy, dm, fabian, tc, eds. A head injury is an injury to the brain, skull, or scalp. Blunt traumatic neck injury radiology reference article.
On the other hand, intimal disruption, dissection, and thrombosis of blood vessels can occur if there is any blunt injury to the neck or any traction injury to shoulder 7. Resident manual of trauma to the face, head, and neck aaohns. Blunt traumatic neck injury is uncommon because it is usually protected by the head, shoulders, and chest. Airway trauma noniatrogenic injury to the airway could present as an isolated complex injury or part of. There are many different reasons for developing neck pain. In this type of injury, there is damage to blood vessels as they are. Screening ct angiography for pediatric blunt cerebrovascular injury with emphasis on the cervical seat belt sign. Major nerve injury occurs in 38% of patients sustaining penetrating neck trauma. The neck is divided into 3 zones, which become important in evaluating and managing these patients, especially with regard to the structures lying within each division. Blunt cerebrovascular injury radiology reference article. These injuries can occur in the setting of polytrauma or injury to the craniocervical region. Penetrating injury related to gsw or stab wounds are going to inflict a different pattern of injury. Blunt cerebrovascular injury bcvi to the carotid artery is a relatively rare injury that is difficult to identify even with imaging. Neck vascular injury in blunt force trauma, carotid dissection in blunt neck trauma, carotid artery injury in blunt neck trauma, traumatic carotid dissection.
Epidemiology it is often part of multitrauma with a significant series of blunt trauma cta reporting an incidence of approximately. Blunt abdominal aortic injury baai is a rare injury with less than 200 cases in the current reported world literature, mostly in case report format. This page includes the following topics and synonyms. Isolated thyroid rupture and hematoma are rare following blunt neck injury and can lead to airway compromise and the need for emergency management. Spinal cord injury occurs infrequently and almost always results from direct injury rather than secondary osseous instability. Penetrating neck trauma western trauma association. Pdf the management of penetrating neck injury researchgate. Penetrating neck trauma cpg the eastern association for the. Traumatic neck injuries are rare in children due to their comparatively short necks, and the relative protection afforded by the mandible and cervical spine. Other times, the person has suffered an injury leading to tmj dysfunction. Note that the larynx and trachea are the most anterior structures and the most likely to be injured first. Pdf pneumomediastinum and subcutaneous emphysema due. Traumatic neck and skull base injuries radiographics. Any injury occurring to the mandible, temporomandibular joint, surrounding ligaments or muscles of the face and neck has the potential to cause temporomandibular disorders tmd.
The anaesthetic management of the the authors 2019 airway. Most of the reported patients are operated on urgently, and neck exploration confirms the diagnosis of thyroid gland injury. Jul 12, 2017 injury to the pharynx or the esophagus occurs in 515% of cases. Swallowing difficulties caused by trauma to the head or neck. What are the indications for immediate or vs cta in managing penetrating neck trauma 3 describe an approach to managing acute neck trauma in the er. The purpose of our study is to identify risk factors associated with cervical spine injury in children after blunt trauma.
Pdf pneumomediastinum and subcutaneous emphysema due to. Blunt carotid injury bci is a rare but potentially devastating injury with a reported incidence of 0. Blunt traumamay result in crushed larynx, tracheal disruption, expanding hematoma, esophageal leak. Cervical internal carotid artery injuries due to blunt trauma. It is often caused by a rapid deceleration with the neck striking the steering wheel or dashboard. Cervical spine collar clearance in the obtunded adult blunt trauma patient 2015. Rates of mortality and neurologic morbidity ranging from 540% and 4080%, respectively, have. Patients with acute blunt trauma to the neck and just posterior midline cervical tenderness received acetaminophen 15 mgkg intravenously after. Penetrating traumamay result in injury to major vascular structures, pharynx, larynx, trachea, esophagus. Suspected spinal injuries does the patient meet adultpediatric major trauma criteria with a blunt mechanism of injury. Only a few isolated cases of thyroid rupture caused by blunt neck trauma have been reported in patients with normal thyroid glands 37. Initially a combined specialty of eye, ear, nose, and throat.
Cervical internal carotid artery injuries due to blunt trauma solomon batnitzky,1, 2 hilton i. These injuries are most commonly identified in trauma patient populations, with highenergy injury mechanisms to the head, neck, and thorax as predisposing factors. Blunt neck trauma can result in laryngeal trauma, such as tears and possibly crush injury and are frequently associated with mvcs. Esophageal injuries are often clinically silent, so they ought to be investigated and ruled out. Blunt neck trauma maxillofacial injury neck vascular injury in blunt force trauma penetrating neck trauma vertebral artery injury in blunt neck trauma back links pages that link to this page nexus cervical spine decision rule seat belt sign neck vascular injury in blunt force trauma vertebral artery injury in blunt neck trauma denver. Bci results in severe disability or death if undiagnosed. Airway trauma noniatrogenic injury to the airway could present as. Airway occlusion or vascular catastrophe is the most immediately. Evaluation for blunt cerebrovascular injury has generated immense controversy with wide variations in recommendations regarding the need for evaluation and the optimal imaging technique.
Pdf the evaluation and management of hemodynamically stable patients with penetrating neck injury has evolved considerably over the. Zone ii is the most common area of injury and most patients will require neck exploration. Blunt thoracic trauma btt, pain management in 2004. Blunt cerebrovascular injury practice management guidelines. Pneumomediastinum may develop in up to 10% patients who have sustained blunt cervical or thoracic. Pdf penetrating neck injuries are serious as there is a high concentration of vital structures in close proximity to each other in a compressed. Blunt abdominal aortic injury journal of vascular surgery. The larynx or the trachea is injured in 412% of cases. Blunt cerebrovascular injury bcvi is a collective term used to describe blunt force injuries to the cervical carotid and vertebral arteries. Thyroid injury secondary to blunt neck trauma is uncommon and mostly occurs in patients with preexisting goiters 1, 2.
Most deaths 80% are directly attributable to the bcvi and not to associated injuries. Not only can the pain be present in the neck itself, but symptoms such as headaches or pain, tingling, andor numbness into the upper extremity, can be related to the neck. When neck trauma results from a motor vehicle crash, inquire about seat belt use, location of the patient in the car driver or front or back seat passenger, deployment of an air bag, and magnitude of car damage eg, intrusion, steering column and windshield intact or broken. Because of the rarity of blunt trauma to the thyroid gland, no consensus has emerged as to itsworkup or management. In addition to blunt and sharp mechanisms, there is the situation of thermal energy in the form of heat, cold, or chemical agent, which generates the heat or. Minor head injuries may bleed a lot, while some major injuries don. Minor blunt neck injury from childhood trauma is a relatively common condition which can be potentially lifethreatening in only rare circumstances.
According to some studies, injury is the leading cause of tmd. Vascular injury to the neck may result in dissection, occlusion, pseudoaneurysm formation, or frank extravasation resulting in stroke or death. This could be by either blunt or penetrating injury, but most commonly it is a blunt mechanism of injury. Blunt trauma to the neck, excluding cervical spine injuries, represents only 5% of all neck trauma, but can be very challenging to assess since its presentation is often delayed. Neck trauma is common, and may result from blunt, penetrating, or com bined mechanisms. Rates of mortality and neurologic morbidity ranging from 540% and 4080%, respectively, have been reported among patients presenting with bci 1. It can be hard to assess the severity of the injury just by looking. Isolated thyroid hematoma after blunt neck trauma presented. These injuries are most commonly identified in trauma patient populations, with highenergy injury mechanisms to the head, neck, and thorax as. Blunt trauma knowledge for medical students and physicians. Neck vascular injury in blunt force trauma, carotid dissection in blunt neck trauma, carotid artery injury in.
The most common signs of significant abdominal trauma are pain, gastrointestinal hemorrhage, hypovolemia, and peritoneal irritation. The transfer of kinetic energy may be blunt or sharp in nature. Blunt neck trauma from coreem references desai nk, et al. Vascular injury in trauma the vascular system is made up of vessels that carry blood throughout the body. Blunt trauma is most commonly due to motor vehicle accidents and is a major cause of morbidity and mortality in all age groups. Penetrating injury to the neck mostly gives rise to cervical vascular injuries.
We conducted a casecontrol study of children younger than 16 years, presenting after blunt trauma. Multisection ct and ct angiography are commonly performed to assess these injuries in the emergency department. Resident manual of trauma to the face, head, and neck. Trauma violence to the head and neck region can cause brain damage or whiplash injury and the consequent problems can include swallowing difficulties dysphagia, or paralysis in the face and pharynx, etc.
Jul 21, 2015 other times, the person has suffered an injury leading to tmj dysfunction. Neck trauma can be split into penetrating injury and blunt injury. Neck trauma references bee, tk, claridge, ja, and croce, ma. Traumatic phrenic nerve injury is well recognised after both penetrating and blunt trauma to the neck. Blunt neck trauma can cause serious morbidity and mortality rates of up to 40 per cent, but there is a paucity of literature on the topic. Neck trauma society for academic emergency medicine. Major vascular injuries are evident with expanding hematoma. Physical exam may be misleading as neck trauma may show subtle symptoms and signs prior to airway obstruction or physiologic. A case illustration with recommendations for diagnosis and treatment bestanyama,1,2 danielatreitl,1,2 jefferywessell,3. This could be by either blunt or penetrating injury, but most. Airway compromise may result from laryngotracheal injury. Feb 07, 2010 blunt cerebrovascular injury is uncommon 0.
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