Written by: Melissa Smith, MD (NUEM ‘28) Edited by: Zemenay Bekele, MD (NUEM ‘27)
Expert Commentary by: Jacob Stelter, MD (NorthShore, Endeavor Health)
Expert Commentary
Thank you Drs. Smith and Bekele for this excellent and concise review of penetrating neck trauma. You correctly summarized the important principles when evaluating a patient with a penetrating wound to the neck. These patients are critical to evaluate immediately upon arrival to the ED, as they can decompensate quickly. Vascular injuries of the neck can lead to rapidly expanding neck hematomas which, in turn, can cause airway compromise. Airway management should be a top priority in these patients along with hemorrhage control. When in doubt, intubate. It is better to be on the side of caution and being proactive than to be faced with a difficult intubation from an expanding hematoma. This should be considered as well when a patient is needing to be transferred to another facility. It may be best to preemptively intubate before transfer than to have an airway compromising situation develop en route. Utilizing "hard" and "soft" signs is an important triage tool, particularly if you are in a lower resource environment without immediate access to surgical specialists.
While the textbook answer for penetrating neck trauma is an injury that violates the platysma, this is often very difficult to ascertain on clinical exam and evaluation. My practice has been to treat all neck wounds as penetrating unless it clearly is a very superficial wound without deeper extension. When considering imaging, it is best to obtain a CT angiogram of the neck. This will protocolize the contrast to evaluate for occult vascular injuries. As appropriately identified, while Zone II injuries tend to be higher risk, these are often not being routinely taken to the operating room anymore. Particularly with the ease of access to high-fidelity CT scanning, stable patients can often have imaging obtained first to determine if an operative intervention is required.
Dr. Jacob Stelter, MD
Emergency Medicine, Sports Medicine, NorthShore, Endeavor Health
How To Cite This Post:
[Peer-Reviewed, Web Publication] Smith, M. Bekele, Z. (2026, August 3). Penetrating Neck Trauma [NUEM Blog. Expert Commentary by Stelter, Jacob]. Retrieved from http://www.nuemblog.com/blog/penetrating-neck-trauma.
