ABCDE
Penetrating Neck Trauma: Platysma Breached
Resuscitate
Emergency airway
call
Immediate operative
exploration
Hard signs of vascular
or aerodigestive injury?
Yes
No
No
CXR
AP /Lateral neck
Hard signs -
of vascular injury
•
Severe/pulsatile bleeding
•
Rapidly expanding or pulsatile
haematoma
•
Shock not responding to fluid
•
Vascular bruit or thrill
•
Absent or faint radial pulses
•
Signs of cerebral ischaemia
of aerodigestive injury
•
Large volume haemoptysis or
haematemesis
•
Bubbling wound
•
Severe respiratory distress
•
Large volume subcutaneous air
Soft signs?
Yes
Investigate
further
Abnormal?
CXR
CT angiogram
Yes
No
No
Perform as
indicated
Soft signs -
•
Minor bleeding
•
Non-expanding haematoma
formation
•
Minor haemoptysis or
haematemesis
•
Minor subcutaneous air
•
Shock that has responded to
fluid
•
Dysphonia
•
Dysphagia
Observe
Yes
Operative
management
or further
investigations
indicated