![]() ![]() Management of esophageal perforation in adults. ![]() Ultimately, the goals of managing neck trauma are to maintain a patent airway, control hemorrhage, and avoid worsening any neurologic impact. This remains an area of some controversy. Institutional guidelines should be developed to maintain a consistent approach to the timing of cervical collar removal and when MRI is necessary to evaluate for ligamentous injury. Injuries to the cervical spine should be assumed in all trauma patients until CT imaging of bony structures is obtained. In stable patients, anticoagulation, endovascular repair, and open surgical techniques may be necessary to decrease the risk of stroke. Management of these injuries in the unstable patient should focus on hemostatic control. CTA is becoming the imaging study of choice, especially for initial screening. Vascular injury should be suspected in patients with hard signs and evaluated further in patients with soft signs. CT technology has advanced and should be performed in all stable patients with suspected aerodigestive injuries. Esophageal injuries are difficult to predict and carry a high mortality when there is a delay to diagnosis. The loss of a patent airway remains a significant cause of mortality, and clinicians must have a stepwise approach to these challenging cases. Airway injuries must be managed immediately and continued oxygenation and ventilation provided. Neck injuries are rare but carry significant morbidity and mortality. ![]()
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