open wounds such as knife wounds to the neck which penetrate platysma are potentially life threatening with potential for vascular, trachea, oesophageal, nerve injury as well as pneumothorax, etc.
wounds are usually assessed according to zones
zone 1
the area between the clavicles and the cricoid cartilage
highest risk of lethal injuries, particularly vascular and delayed Dx of oesophageal injuries
usually requires CXR to exclude pneumothorax as well as consideration for CT angio
oesophagoscopy should be considered if oesophageal injury is suspected
zone 2
the area between the cricoid cartilage and the angle of the mandible
most common zone for penetrating injuries
consideration for CT angio
zone 3
the area between the angle of the mandible and the base of the skull
less amenable to physical examination and difficult to explore during surgical evaluation
consideration for CT angio
Mx in ED
usual trauma Mx protocols including ABCDE, dressings to reduce bleeding, IV access, Xmatch if indicated
NB. if cervical spine injury is possible then usual Cx spine precautions should be used
Hx and exam to assess wound(s)
if wound is thought to be deeper than platysma then consider:
CXR - esp. if Zone 1
CT angio
oesophagoscopy if oesophageal injury is suspected - especially if Zone 1
referral for surgical mx - surgical exploration is easiest for zone 2 injuries