Signs and Symptom

8/13/2019 Signs and Symptom

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Signs and symptom

Signs of laryngeal or tracheal injury

Voice alteration

Hemoptysis

Stridor

Drooling

Sucking, hissing, or air frothing or bubbling through the neck wound

Subcutaneous emphysema and/or crepitus

Hoarseness

Dyspnea

Distortion of the normal anatomic appearance

Pain on palpation or with coughing or swallowing

Pain with tongue movement

Crepitus: Noteworthy in only one third of cases

Signs of esophageal and pharyngeal injury

Dysphagia

Bloody saliva

Sucking neck wound

Bloody nasogastric aspirate

Pain and tenderness in the neck

Resistance of neck with passive motion testing


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Crepitus

Bleeding from the mouth or nasogastric tube

Signs of carotid artery injury

Decreased level of consciousness

Contralateral hemiparesis

Hemorrhage

Hematoma

Dyspnea secondary to compression of the trachea

Thrill

Bruit

Pulse deficit

Signs of jugular vein injury

These include hematoma, external hemorrhage, and hypotension.

Signs of spinal cord or brachial plexus injury

Diminished upper arm capacity

Quadriplegia

Pathologic reflexes

Brown-Squard syndrome

Priapism and loss of the bulbocavernous reflex


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Poor rectal tone

Urinary retention, fecal incontinence, and paralytic ileus

Horner syndrome

Neurogenic shock

Hypoxia and hypoventilation

Signs of cranial nerve injury

Facial nerve (cranial nerve VII): Drooping of the corner of the mouth

Glossopharyngeal nerve (cranial nerve IX): Dysphagia (altered gag reflex)

Vagus nerve (cranial nerve X, recurrent laryngeal): Hoarseness (weak voice)

Spinal accessory nerve (cranial nerve XI): Inability to shrug a shoulder and to laterally rotate the chin

to the opposite shoulder

Hypoglossal nerve (cranial nerve XII): Deviation of the tongue with protrusion

See Clinical Presentation for more detail.

Diagnosis

Imaging studies

In addition to cervical and chest radiography, the following supplementary tests may be useful:

Computed tomography (CT) scanning

Magnetic resonance imaging (MRI)

Color flow Doppler ultrasonography

Contrast studies of the esophagus


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Interventional angiography

Endoscopy

Laryngoscopy, bronchoscopy, pharyngoscopy, and esophagoscopy may be useful in the assessment of

the aerodigestive tract. Rigid endoscopes are superior to flexible scopes.

See Workup for more detail.

Management

In neck trauma, emergency department care commences with assessment and stabilization of the

patients airway, breathing, and circulation (ABCs):

Airway: Perform emergent orotracheal intubation in patients displaying signs of acute or impending

respiratory distress

Breathing: Ventilatory distress that persists beyond competent intubation indicates a possible tension

pneumothorax, which requires needle decompression and chest tube placement

Circulation: Bleeding that originates from neck trauma is controlled with direct pressure; in selected

cases, bleeding that cannot be controlled or reached with direct pressure may benefit from balloon

tamponade

In rare instances, when applying direct pressure to wounds is impractical, a cricothyroidotomy may be

required, with subsequent packing of the pharynx as a temporary strategy.

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Signs and Symptom