Control bleeding with direct pressure and avoid blind clamping of vessels.
+Not attempt rapid sequence intubation, as these patients invariably require a surgical airway.
+Recognize Zone II injuries as occurring between the angle of the mandible and the thyroid cartilage.
+Order fiberoptic esophagoscopy, which if negative excludes a significant esophageal injury.
+Order a Gastrografin swallow, which if negative excludes a significant esophageal injury.
Up to 25% of patients with esophageal injuries have negative Gastrografin studies. A barium upper GI series may improve sensitivity. Fiberoptic esophagoscopy has up to a 20% false-negative rate. Posterior triangle injuries may include subclavian vessel and vertebral artery lacerations; thus, subclavian venous access should be avoided. Complications of penetrating injuries to the posterior triangle includes hemothorax and tension pneumothorax. The best initial method to control vascular hemorrhage in the neck is direct pressure. Blind attempts to clamp vessels can result in serious injury to associated structures. The management of neck injuries has been aided by dividing the neck into three zones and the availability of arteriography. Zone III injuries occur above the angle of the mandible and the cricoid. Zone II injuries occur between the mandible and the cricoid. Zone I injuries occur below the cricoid cartilage and above the clavicle.