Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXVII: Wounds and Injuries of the Neck

Immediate Life Threatening Injury, Major Bleeding, and Airway Obstruction

United States Department of Defense

Severe and even fatal external hemorrhage can occur from innocuous-appearing wounds of the neck. Probing or blind clamping of an open, bleeding neck wound rarely controls hemorrhage and frequently causes further injury. The hemorrhage in many severe neck injuries is venous in origin and can be controlled by external pressure. Airway compromise may result from direct trauma, from endotracheal blood and blood clots, from laryngotracheal edema, or from nerve injury. Endotracheal intubation in these cases may be impossible, particularly in patients with extensive bleeding from wounds of the mouth or pharynx. When airway obstruction persists in the patient who cannot be intubated orally, cricothyroidotomy provides rapid and safe airway control. This should be viewed as a temporizing life-saving procedure which will be replaced by a tracheostomy under controlled circumstances if one anticipates the requirement for airway control lasting more than 48 hours.

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Operational Medicine 2001

Health Care in Military Settings

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