Approach to penetrating neck injury Quiz: Ace Your Exams

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A 43-year-old man presents to the trauma bay after a gunshot wound to the neck. Primary survey is intact, and secondary survey reveals two bullet wounds. One is 2cm superior and lateral to the sternal notch, and the other is on the posterolateral aspect of the neck. The patient is hemodynamically stable. The remainder of the secondary exam is unremarkable, and the bullet wounds are hemostatic. CT-A is obtained of the head, neck and chest which reveals no sign of laryngotracheal or vascular injury; however, there is soft tissue edema on the right anterior cervical esophagus. In addition, the patient has started to spit up bloody saliva. Which of the following is the most appropriate next step in management?

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Make NPO and observe for 24 hours

Obtain a CXR to evaluate for pneumomediastinum

Perform a gastrografin swallow evaluation

Perform a bronchoscopy

Transport to the operating room for exploration