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A previously healthy 30-year-old man was shot at close range with a low-caliber handgun. A 911 call was placed immediately and paramedics were on the scene within 10 minutes. The victim was fully awake and cooperative. There was a single gunshot entrance wound in the midline at the level of the thyroid cartilage (Figure 34-1). The wound was about 5 mm in diameter and air was noted to be escaping from it. There was minimal bleeding. The patient complained of pain in the area of the anterior neck and the left scapula. He also complained of dyspnea and coughed up scant bloody sputum. He had no allergies, was on no medications, and was previously healthy.
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Vital signs at the scene were: blood pressure (BP) 140/60 mm Hg, heart rate (HR) 90 beats per minute (bpm), respiratory rate (RR) 22 breaths per minute, oxygen saturation (SaO2) was 97%. Glasgow Coma Scale was 15. One IV was placed in each upper extremity and oxygen was administered by non-rebreathing facemask (NRFM). The patient was immobilized on a spine board and transported to the emergency department (ED). Transport time was 20 minutes.
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On arrival in the ED the patient was awake and responded appropriately. Vital signs were: BP 140/90 mm Hg, HR 96 bpm, RR 20 breaths per minute, SaO2 was 98% on NRFM. He was hoarse, had scant hemoptysis, and complained of pain in the anterior neck and left scapular area. Air could again be appreciated escaping from the neck wound. There was minimal bleeding. Subcutaneous emphysema was palpable in the anterior neck but no hematoma was detected. No exit wound was identified. Air entry was decreased on auscultation of the left chest. The Glasgow Coma Scale was 15 and there were no neurologic deficits. The remainder of the examination was unremarkable.
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34.2.1 How Common Is Penetrating Neck Injury?
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Penetrating neck injury (PNI) has been reported to occur in 1% to 10% of all trauma patients1,2 and in 0.4% to 5% of major penetrating trauma victims.3 Not all PNIs involve vital structures. In a review of 26 reported series with a total of 4193 patients with PNI, there were 1285 vascular injuries (31%), 331 laryngotracheal injuries (8%), and 354 digestive (pharyngeal and esophageal) injuries (8.4%).4 Others have reported vascular injury in 13.3% to 37%2,5-7 of PNIs, aerodigestive tract injury in 6.3% to 18.5%,6-9 and esophageal injury in 0.9% to 8%.7,8,10,11 Pharyngoesophageal injury was reported by Thoma et al in 8.9% of PNIs.6
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34.2.2 What Is the Mortality Associated with PNI?
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The mortality associated with PNI has been reported in multiple series and ...