Evaluation and Management of Neck Trauma Niels K. Rathlev, MD * , Ron Medzon, MD, Mark E. Bracken, MD Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, One Boston Medical Center Place, Boston, MA 02118, USA Blunt and penetrating trauma to the neck can result in life-threatening in- juries that demand immediate attention and intervention on the part of the emergency physician and trauma surgeon. This article provides a literature- based update of the evaluation and management of injuries to aerodigestive and vascular organs of the neck. A brief review of cervical spine injuries related to penetrating neck trauma is also included. Airway injuries chal- lenge even the most skilled practitioners; familiarity with multiple ap- proaches to securing a definitive airway is required because success is not guaranteed with any single technique. Esophageal injuries often present in subtle fashion initially, but more than a 24-hour delay in diagnosis is asso- ciated with a marked increase in mortality. In total, 7% of injuries to critical structures of the neck involve major arterial vascular structures, including the subclavian and internal, external, and common carotid arteries [1]. Ar- terial injuries are a major source of morbidity and mortality for these patients. Currently, spinal cord injuries and thrombosis of the common and internal carotid arteries account for 50% of all deaths attributable to blunt and penetrating neck trauma. Aerodigestive injuries Epidemiology Penetrating injuries to the airway and digestive tract are primarily caused by gunshot wounds and stab wounds. Wounds requiring operative repair are extremely rare. In one series of 12,789 consecutive trauma patients * Corresponding author. E-mail address: nrathlev@bu.edu (N.K. Rathlev). 0733-8627/07/$ - see front matter Ó 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.emc.2007.06.006 emed.theclinics.com Emerg Med Clin N Am 25 (2007) 679–694