A -year-old male is transported to the trauma center by police officers following a physical altercation. He sustained a stab wound to the left anterior neck. On arrival, the patient is highly agitated and holding a blood-soaked garment to his neck. Blood is actively oozing from the wound site. His voice is noticeably hoarse, and he is coughing up bright red blood. Vital signs reveal a temperature of (), blood pressure of , pulse of , and respiratory rate of . Oxygen saturation is on room air. Physical examination demonstrates an expanding, pulsatile hematoma on the left side of the neck and audible biphasic stridor. Which of the following is the most appropriate immediate next step in the management of this patient?
- Establishment of a definitive airway via direct laryngoscopyAnswer
- BCross-sectional vascular imaging of the cervical region
- CEmergent transfer to the operating suite for surgical exploration
- DAdministration of a rapid isotonic crystalloid bolus
- EPlacement of a rigid cervical spine immobilization collar
Answer
Establishment of a definitive airway via direct laryngoscopy is the correct next step.
The correct action is to establish a definitive airway. This patient presents with penetrating neck trauma and classical 'hard signs' of severe aerodigestive and vascular injury, specifically an expanding pulsatile hematoma, hemoptysis, hoarseness, and stridor. These signs indicate impending airway loss. According to Advanced Trauma Life Support (ATLS) principles, securing a definitive airway is the highest priority (Airway always precedes Breathing and Circulation) and must be accomplished before any further diagnostic testing, imaging, or movement of the patient.
Step-by-Step Solution
Key Concept
In penetrating neck trauma, the presence of 'hard signs' such as an expanding hematoma, stridor, or hemoptysis mandates immediate establishment of a definitive airway before any other diagnostic or therapeutic interventions.