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Lesson

Penetrating Neck Trauma

11 min Trauma Skip to quiz

Objective: Treat penetrating neck trauma as an airway-and-hemorrhage problem: pressure, no probing, early destination, and a CICO plan if the neck is swelling.

Why This Is Hard

The wound looks small. Crews peek inside, pull clots, and then cannot stop the fountain. NAEMSP/trauma teaching: hard signs (airway compromise, expanding hematoma, bubbling, pulsatile bleeding, stroke-like findings) go now. Soft signs still need a trauma center. Zone trivia does not change the street plan.

On this truck
  • Direct pressure with a gloved hand or packing that you can still watch the airway around. Do not blindly clamp.
  • Sit up if they can. Suction. Be ready to lose the airway to hematoma.
  • C-spine is a mechanism conversation; a crashing airway still wins. Helmet/SMR lessons still apply when they are stable enough.

Street Sequence

  1. MARCH: massive external bleed first — pressure. Then airway.
  2. Do not probe, do not pull impaled objects, do not take the clot on a tour.
  3. Hard signs (airway, expanding hematoma, bubbling, shock from the neck): short scene, trauma center, early notify.
  4. If the airway is disappearing: SGA or trained FONA per protocol. This is a predicted difficult airway.
  5. Two large IVs/IO en route. Do not delay for a full neuro exam if they are bleeding into the neck.

Field Rules (Education)

  • Hard signs (education): airway compromise, expanding hematoma, pulsatile/brisk bleeding, bubbling wound, focal neuro deficit. These leave now.
  • No exploration: you cannot ligate the carotids on a porch. Pressure and destination.
  • Airway: hematoma distorts landmarks. Collecting looks is how CICO happens. See FONA and attempt-limit lessons.
  • Zones (I/II/III) are for surgeons. Your destination is a trauma center that can operate on the neck — not the closest clinic.
Say out loud
  • Penetrating neck — pressure, not probing
  • Airway clock if the neck is swelling
  • Hard signs: short scene, trauma center
  • CICO plan if the voice changes

Field Pitfalls

  • Sticking a finger in “to see how deep.”
  • Clamping blindly in a pool of blood.
  • Three intubation attempts while the other side of the neck balloons.

Practice

60-second drill

Stab wound zone II, expanding hematoma, voice hoarse, sat 96% sitting. First three actions and the radio sentence. What do you not do to the wound?

Related: Front-of-Neck Access, Massive Hemorrhage First.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Street decisions from this lesson only. After you check, the key is highlighted. Education practice — not a certification exam.

1. The correct street move for a bubbling, bleeding neck wound is:
2. An expanding neck hematoma with voice change is:
3. Anatomic zones I, II, and III:
4. If the airway is disappearing from hematoma, serial DL attempts:
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