Penetrating carotid artery injuries

Carotid arterial injuries are the most difficult and certainly the most immediate life-threatening injuries found in penetrating neck trauma. Their propensity to bleed actively and potentially occlude the airway makes surgical intervention very challenging. Their potential for causing fatal neurologic outcomes demands that trauma surgeons exercise excellent judgment in the approach to their definitive management. Frequently, the rapidity with which these injuries bleed causes early airway occlusion from the extensive hemorrhage contained within the fascial planes of the neck, often necessitating the immediate achievement of an airway either by intubation and occasionally via surgical cricothyroidotomy. Establishing a surgical airway can be a difficult procedure, given the distortion of anatomic landmarks by hemorrhage. It is also fraught with danger, as the incision may release the contained hematoma resulting in torrential bleeding that can obscure the operative site and place the patient at risk for aspiration. These injuries incur high morbidity and mortality rates. Their neurologic sequelae can be devastating. Fortunately, they are not common.