Case

EMTs are responding to an emergency call to a building site. At the scene, they find a patient with acute respiratory difficulty. The EMTs observe a nail from a nail gun impaling the patients neck at the level of the hyoid bone. The left side of their face is pale and there is an expanding mass deep to the skin at the site of the nail. The patient starts to cough blood and struggles to breathe, losing consciousness.

Question 1/3 - What structures do you think have been injured?

Click on your selected option(s) below  (correct = 2,  possible = 4, over-thinking = 5+)

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Incorrect. The thyroid gland spans the trachea at a level inferior to that of the hyoid bone (spans tracheal rings inferior to the thyroid/cricoid cartilages).

Correct! The facial artery is a major supply to the face, the observation of the cool pale left side suggests lack of blood flow to the face. Additionally, the expanding mass under the skin suggests an expanding hematoma from major bleeding.   

Possible, but unknown from the presentation. While any artery in this region may have been injured and the expanding mass indicates the presence of an expanding hematoma from major bleeding, the symptoms do not immediately indicate lingual artery injury.

Incorrect. The sternothyroid muscle spans from the thyroid cartilage to the sternum, thus the muscle is inferior to the level of the hyoid bone where the nail is located.

Correct! Coughing blood and respiratory distress suggests that there is airway compromise.

Possible, but unknown from the presentation. The nail could have injured the esophagus, however imaging studies would likely be needed to make that determination.

Incorrect. The lung apex protrudes into the base of the neck, but the hyoid bone it quite superior in the neck well above the level of the lung excursion into the neck.