Pediatric emergency medicine trisk 3567 3567
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TABLE 112.4
INDICATIONS SUGGESTING SURGICAL EVALUATION IN PATIENTS
WITH NECK TRAUMA
Unstable vital signs
Expanding or massive hematoma
Pulsatile or active bleeding
Hemorrhagic shock
Vascular deficits in the upper extremities
Abnormal distal pulses (brachial, superficial temporal, ophthalmologic, fundi)
Hematemesis, hemoptysis, epistaxis
Hemothorax
Progressive respiratory distress
Airway obstruction
Expanding subcutaneous emphysema
Bubbling or sucking wound
Pneumothorax
Progressive neurologic deficits
Hemiparesis
Horner syndrome
Cranial or cervical nerve dysfunction
Diaphragm paralysis
Decreased sensorium
Neurologic deficits in upper extremity
Increasing dysphagia
Odynophagia or dysphonia
Hoarseness
Severe neck pain or tenderness
High-velocity wounds (rifles, explosions)
Multiple low-velocity wounds
Ancillary radiographic studies not available
Experienced observation personnel not available
Surgical evaluation may yield false-negative results with esophageal
lacerations, small vessel lacerations, pharyngeal lacerations, or tracheal injuries.
The patient who has stable vital signs, no symptoms of impaired neurologic or
