Review article: Emergency department assessment and management of stab wounds to the neck

Abstract

A stab wound to neck is an infrequent but highly important presentation to the ED in Australasia. Injuries to the two large neurovascular bundles that are vital to life might occur with associated injuries to midline aerodigestive structures. A literature review was undertaken to discuss the assessment and management of this injury in the emergency medicine setting.

Evolving role of video laryngoscopy for airway management in the emergency department

“…What is difficult in a particular patient might vary, as for example in the young woman who might be an easy intubation when undergoing anaesthesia for infertility, but might develop a difficult airway when she is pregnant with eclampsia, or in a hard collar after a motor vehicle incident. However, some situations will always be challenging, such as the patient who has a stab wound to the neck with a rapidly expanding haematoma, or a patient with critical asthma 2,3 …”

“…However, some situations will always be challenging, such as the patient who has a stab wound to the neck with a rapidly expanding haematoma, or a patient with critical asthma. 2,3 Finally, the environment will affect the degree of difficulty. Laryngoscopy and intubation at the roadside with high ambient light, limited equipment and usually an unstable patient are generally more difficult than in the ED.…”

Should reading a journal article really change my practice?

“…on convulsive and non‐convulsive status epilepticus, 13 Isoardi on the limited role of pelvic examination in early pregnancy bleeding, 14 Chong et al . on the challenge of increasing intern numbers, 15 Gallop on the use and efficacy of phenytoin, 16 Casey and de Alwis on stab wounds to the neck, 17 and Jones and Schimanski on the four‐hour rule 18 . Surely every reader must find something to pique his or her interest from such an eclectic list?…”

“…Lastly, aligned to Emergency Medicine Australasia's Mission Statement to 'To fairly publish valid emergency medicine related scientific information to educate, enlighten, inform and enthuse' many recent articles can be recommended along those grounds, irrespective of the perceived shortcomings of reading a journal article as regards its benefit in actually changing practice. Among review articles alone, many fulfil most, if not all, of the precepts in our Mission Statement, such as Robb et al on the ED implications of the use of the TASER, 9 Holley and Boots on acute severe and near-fatal asthma, 10 Senz and Nunnink on inotrope and vasopressor use, 11 O'Connor and Walsham on thoracolumbar spine imaging in trauma, 12 Shah et al on convulsive and non-convulsive status epilepticus, 13 Isoardi on the limited role of pelvic examination in early pregnancy bleeding, 14 Chong et al on the challenge of increasing intern numbers, 15 Gallop on the use and efficacy of phenytoin, 16 Casey and de Alwis on stab wounds to the neck, 17 and Jones and Schimanski on the four-hour rule. 18 Surely every reader must find something to pique his or her interest from such an eclectic list?…”