Neck trauma
Neck trauma (penetrating and severe blunt) is high‑risk because a compact space contains major vascular, airway and neurovascular structures. Management follows major‑trauma ABCDE priorities but must emphasise catastrophic haemorrhage control, early airway protection, prompt recognition of vascular and aerodigestive injury, and early specialist involvement (NICE NG39; Resuscitation Council UK 2025).
Anatomical zone classification is a useful communication tool to anticipate injured structures and surgical accessibility, but management is guided by physiology and clinical signs rather than zone alone.
Anatomical zones - quick reference
Key pathophysiology to remember
- Rapid exsanguination can occur from carotid or subclavian injuries and an expanding haematoma can cause airway obstruction.
- Open neck veins risk venous air embolism during wound exposure.
- Aerodigestive tract breaches carry high risk of contamination, mediastinitis and sepsis if missed.
- Blunt or penetrating carotid/vertebral injury can cause dissection and delayed cerebral ischaemia.
Initial assessment and priorities
Follow the major‑trauma ABCDE (NICE NG39), but tailor the approach to neck injury.
- Catastrophic haemorrhage: apply immediate direct pressure and haemostatic dressings and pack the wound if needed.
- Activate the massive haemorrhage protocol early for life‑threatening bleeding.
- Airway (A): secure the airway early if it is compromised or at high risk (expanding haematoma, stridor, heavy contamination, reduced consciousness).