The iniuries of this region may be divided into wounds, contusions, the impaction of foreign bodies in the respiratory or alimentary passages, and the local effects of heat and caustics. Sprams and fracture and dislocation of the cervical spine have been considered under the head of Injuries of the Spme. (Chap. VIII.)...<Callout type="warning" title="Be cautious with food intake">Do not give the patient food to swallow to see if it escapes through the wound in the neck, as it may pass into the air-passages and do serious harm.</Callout> Wounds of the neck, inflicted from the outside, are obvious but vary from the most trivial up to those which are almost instantly fatal. The questions of primary interest are (i) wounds of vessels and haemorrhage, and here the ordinary rules will guide the surgeon; (ii) wounds of the an-passages. The main vessels lie so deeply that they are comparatively rarely severed...<Callout type="important" title="Always check for air passage injuries">A wound of the air-passage will be shown by the escape of air from the wound, and oftentimes also by the escape of mucus and frothy blood, and by the loss of voice.</Callout> In cases of gunshot wounds or stab in the neck where the injured parts cannot be so well and so easily explored, the diagnosis has to be more largely inferential. If a soft, puffy, crackling swelling forms which increases on attempts at coughing, it is evidently subcutaneous emphysema from wound of the an-passage; such a wound is also to be diagnosed if the patient coughs up frothy blood...<Callout type="tip" title="Use a laryngoscope for detailed examination">If there is loss of voice or dyspnoea, not otherwise explained, the larynx should be carefully examined with a laryngoscope, and if one of the cords is found in the cadaveric position, and unmoved when the patient attempts phonation or takes a deep inspiration, paralysis of the muscles of that side of the larynx from division of the recurrent laryngeal nerve must be diagnosed.</Callout> In regard to wounds inflicted from the inside it only needs to be pointed out that an exact diagnosis may be quite impossible; haemorrhage may show that a vessel has been wounded, but there may be nothing to indicate what particular vessel is injured, especially where the wound is out of sight...Contusions of the neck may be instantly fatal. Where this is not the case the examination should be conducted with the view of determining whether the hyoid bone or any of the cartilages of the larynx or the trachea have been injured. The arch of the hyoid bone should first be examined to see if there is any irregularity in it, or whether on compressing the two cornua crepitus is obtained, or great pain caused, or whether the bone yields with the normal elasticity...<Callout type="risk" title="Be wary of severe dyspnoea">The trachea is very rarely ruptured; but if after a blow on the lower part of the front of the neck there are severe dyspnoea, a cold, livid countenance weak or lost voice, and emphysema of the neck, and the larynx can be felt to be normal, this injury may be suspected, and the diagnosis will be established by noticing a gap in the trachea, if the state of the patient permits digital examination.</Callout>
Key Takeaways
- Identify and prioritize wounds to vessels and air passages.
- Use a laryngoscope for detailed examination of the larynx.
- Be cautious with food intake when assessing neck wounds.
Practical Tips
- Always keep a laryngoscope handy in emergency situations.
- Learn to recognize signs of subcutaneous emphysema from gunshot or stab wounds.
- Be prepared for potential airway obstructions and manage them accordingly.
Warnings & Risks
- Avoid giving food to patients with neck wounds as it can lead to serious complications.
- Do not assume a wound is minor just because the patient appears stable initially.
- Be aware of the risk of delayed traumatic aneurysms from carotid artery injuries.
Modern Application
While the techniques described in this chapter are rooted in historical practices, many of the principles still apply to modern survival scenarios. Understanding how to diagnose and manage neck injuries is crucial for first responders and medical professionals alike. The use of advanced imaging like X-rays (now replaced by CT scans) has improved accuracy but the core knowledge remains invaluable.
Frequently Asked Questions
Q: How can I determine if a patient's airway is compromised due to a neck injury?
A wound of the air-passage will be shown by the escape of air from the wound, and oftentimes also by the escape of mucus and frothy blood, and by the loss of voice. If you suspect an airway injury, carefully examine the patient's larynx with a laryngoscope to check for any structural damage.
Q: What should I do if I cannot see inside a patient's neck wound?
In cases where the injured parts are out of sight, you may need to rely on inferential diagnosis. Look for signs such as subcutaneous emphysema or changes in voice and breathing patterns. If there is doubt about the integrity of the airway, use a soft catheter or esophageal tube to check if it is visible through the wound.
Q: How can I prevent serious complications from neck wounds?
Avoid giving food to patients with neck wounds as it may pass into the air-passages and cause serious harm. Always be cautious when assessing the patient's ability to swallow, and do not assume a wound is minor just because the patient appears stable initially.