Key examination points for patient with penetrating neck injury (PNI)

Examination	Finding	Concern
General appearance	Declining mental status	Vascular injury or cerebral hypoperfusion (eg, hemorrhage, hypotension)
	Stroke-like syndrome	Vascular injury; stroke; spinal cord injury
	Distress (eg, agitation, respiratory distress)	Hypoxia from airway occlusion or tension pneumothorax
Oropharyngeal examination	Blood in saliva	Pharyngoesophageal injury
Oropharyngeal examination	Hemoptysis, hematemesis, dysphagia, odynophagia	Pharyngoesophageal or laryngotracheal injury
Voice	Stridor	Airway occlusion from multiple sources (expanding hematoma, laryngotracheal injury)
Voice	Dysphonia	Laryngotracheal injury Laryngeal nerve injury
Tracheal position	Shifted trachea	Visceral injury or vascular injury producing mass effect
Tracheal position	Shifted trachea	Tension pneumothorax (most commonly associated with Zone I PNI)
Neck appearance, palpation, auscultation	Expanding hematoma, thrill, or bruit	Vascular injury
	Crepitus	Airway leak, pneumothorax, laryngotracheal or pharyngoesophageal injury
	Anterior neck tenderness	Laryngotracheal injury
Neurologic examination	Focal neurologic deficit	Spinal nerve or cranial nerve injury (neuropraxia versus nerve transection)
Neurologic examination	Horner's syndrome (miosis, ptosis, anhidrosis)	Sympathetic chain injury (consider adjacent vascular injury due to proximity)

Graphic 106783 Version 3.0