A complete history and thorough physical examination are performed. Information obtained from pre-hospital personnel should include mechanism of injury, symptoms, hemodynamic stability, and amount of blood loss at the scene. Once in the Emergency Department, if possible, the patient should be questioned about neck pain, difficulty breathing, dysphagia, odynophagia, hoarseness, hematemesis, hemoptysis, and any neurologic deficits. Examination of the neck requires a search for clinical signs of vascular, aerodigestive, and neurologic injuries. These include arterial bleeding, large or expanding hematomas, diminished pulses or bruits, lateralizing signs, tracheal deviation, air-bubbling through the wound, saliva in the wound, subcutaneous emphysema, and evidence of cranial nerve injuries.
These clinical signs can be divided into hard and soft signs of injury ( Iable 250:1).5 All signs require diagnostic investigation, but hard signs are more often associated with significant injury.
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