ENT

ResponseThink hard and soft signs
Visible bruising/swelling/petechiae
Dyspnoea/stridor
Voice changes
Neurologic deficit
Carotid bruit
Bony cervical spine tenderness
History of LOC or altered GCS
Subcutaenous emphysema

ResponseLarge Y shaped left lateral neck wound
Platysma breached
Through zones 2 and 3
Blood soaked gauze
Soft tissue swelling at the angle of mandible (suspected expanding haematoma)

ResponsePenetrating neck injury with device in situ
left anterior triangle of zone 2 of neck

ResponseZone 1: Clavicles to cricoid cartilage

• Lungs, trachea, great vessels, oesophagus, spinal cord, thoracic duct, cervical nerve trunks
• Angiography, bronchoscopy, oesophagoscopy

Zone 2: cricord cartilage to angle of mandible

• Jugula veins, vertebral and common carotid arteries, trachea, oesophagus, spinal cord, larynx
• Operative exploration

Zone 3: angle of mandible to base of skull

• Pharynx, jugular veins, vertebral arteris, internal carotid arteries
• Angiography, bronchoscopy, oesophagoscopy

ResponseStridor
Acute respiratory distress
Airway obstruction from blood/secretions
Expanding neck haematoma
Profound shock
Extensive subcutaneous emphysema
Altered mental state
Tracheal shift

Relative indications (NO marks as not URGENT indications)
Progressive neck swelling
Voice changes
Progressive symptoms
Massive s/c emphysema of neck
Need to transfer symptomatic patient
Symptomatic patient with anticipated prolonged time away from ED

ResponseMaintain airway patency through upright positioning in comfort position
Optomise oxygenation - 15L O2 via NRBM (Not suitable for NIV or HFNP)
Sek and treat tension pneumo/haemothorax
Notify anesthetics/surgical team for attendance for possible surgical airway
Prep for emergent RSI with ketamine 2mg/kg + roc 1.2 mg/kg
Prepare for difficult airway - surgical airway kit open, neck prepped, senior clinician scrubbed for surgical airway