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Penetrating neck trauma (mechanism of disease)

This is a flowchart on penetrating neck trauma, covering the etiology, pathophysiology, and manifestations. ADDITIONAL TAGS: Risk factors / SDOH Cell / tissue damage Structural factors Medicine / iatrogenic Infectious / microbial Pressure physiology Immunology / inflammation Signs / symptoms Tests / imaging / labs Environmental / exposure Cancer / neoplasm Flow physiology Pathophysiology Etiology Manifestations Thrusting action of a pointed object (e.g., knife, broken bottle) Tissue is lacerated and torn along the path of the object Stab wounds: Depth of injury usually greater than the width Tissue is lacerated and crushed along the path of the bullet Gun shot wounds: Tissue displaced forward and radially → cavitation and pressure injury of nearby structures. Dense organs (liver, bone) absorb more kinetic energy than less dense organs, resulting in greater injury Severity of injury is related to the kinetic energy of the bullet (i.e., weight, velocity) Penetrating neck trauma Penetrating neck trauma Tracheobronchial injury Esophageal injury Vascular injury: carotid artery, vertebral artery, jugular vein) Cranial nerve injury: Pneumothorax: air enters pleural cavity → lung collapse Airway compromise Wound bubbling Extensive subQ emphysema Hoarseness, stridor Hemoptysis, hematemesis Dysphonia (abnormal voice) Mild subQ emphysema Dysphagia Hard signs → requires surgical intervention often bypassing CT imaging Soft signs → requires CTA for further evaluation Hemorrhagic shock (hypotension, tachycardia) Pulsatile bleeding Expanding hematoma Carotid bruit Hard signs Unilateral pulse deficit Signs of stroke Minor bleeding Soft signs Non-expanding hematoma Proximity wound Vagus nerve palsy Recurrent laryngeal nerve palsy Flaccid paralysis of the soft palate Nasal speech Dysphagia, aspiration Postprandial bloating Gastroparesis Chest pain Respiratory distress; hypoxia; ↓ or absent breath sounds Distended neck veins, tracheal deviation Tension pneumo. Obstructive shock Progressively ↑ pressure within chest Bilateral → Aphonia, inspiratory stridor Unilateral → Dysphonia, hoarseness