A trauma patient has a Zone II penetrating neck injury (between cricoid cartilage and angle of mandible) with a large expanding hematoma and hoarse voice. The most appropriate initial management is:

• A CT angiography of the neck before any surgical intervention
• B Immediate operative exploration without further imaging ✓
• C Flexible nasendoscopy to assess larynx before deciding
• D Observation for 6 hours in a monitored environment

Explanation

Hard signs of vascular or airway injury after penetrating neck trauma (expanding hematoma, airway compromise, active hemorrhage, neurological deficit, air bubbling through wound) mandate immediate operative exploration without delay for imaging. Zone II injuries are particularly accessible surgically. CT angiography is appropriate for soft signs (stable hematoma, dysphagia, minor haemoptysis) in hemodynamically stable patients without hard signs. An expanding hematoma with hoarseness indicates both vascular and airway compromise requiring definitive surgical control.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.