Pediatric emergency medicine trisk 3576 3576
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those below present with hemoptysis and persistent air leak, although any or all
symptoms and signs listed in Table 112.3 may be present. If a laryngeal injury is
noted, the patient should be evaluated carefully for other commonly associated
injuries, including in the cervical spine, chest, face, pharyngoesophageal area, and
recurrent laryngeal nerve palsy.
Symptoms and signs of hyoid injury include pain in the throat that worsens with
swallowing or coughing, tenderness to palpation, neck crepitus, pain on head
rotation, dysphagia, dyspnea, or dysphonia.
The symptoms and signs associated with esophageal injury are listed in Table
112.3 and include neck tenderness and pain, dysphagia, odynophagia, drooling,
crepitus, subcutaneous emphysema, hematemesis, fever, and mediastinitis (see
Chapters 56 Pain: Dysphagia and 115 Thoracic Trauma ).
The clinician must consider subclavian or innominate vessel injuries if a
fracture of the clavicle or first rib is identified.
Patients with signs or symptoms of facial or neck burns will require careful
assessment, as airway edema may initially be subtle but progress rapidly. Early
recognition and protection of a difficult airway are paramount.
Triage Considerations
These patients require expedited evaluation, close monitoring and providers
should anticipate difficult airway management. Early transfer to a pediatric trauma
center should be considered if appropriate surgical or critical care staff is not
available.
Clinical Assessment
As with all trauma patients, initial rapid assessment of their airway, breathing, and
circulatory status should be completed. Given the risk of airway injury, particular
attention must be paid to subtle signs and symptoms of airway injury ( Table
112.3 ). Continued monitoring with repeat examinations is important in the
recognition and identification of vascular and neurologic injuries ( Table 112.3 ).
Refer to penetrating trauma clinical assessment section for detailed
recommendations.
Management
Blunt neck trauma requires similar vigilance and potentially similar diagnostic
modalities as penetrating trauma. Refer to penetrating trauma section for
management recommendations. Special management considerations are included
there.
