ABSTRACT
Blunt and penetrating injuries to the face and neck can result in mortality from airway compromise, both from direct injury and from bleeding into the trachea. Standard intubation should be performed if possible, but should there be any doubt or difficulty, surgical cricothyroidotomy is recommended. Haemorrhage from the mouth and nose should be arrested by packing in conjunction with nasal epistat, optimally following intubation. Penetrating neck injuries should be packed with haemostatic dressings with pressure applied and may require damage control surgery. If possible, PNI should be imaged by CT prior to surgical exploration—unless indications for immediate surgery exist, such as hard signs suggestive of haemodynamic instability or airway compromise. Surgical options include repair, which in turn may require temporary shunting, and ligation. Facial fractures should be temporarily stabilised if they have the potential to cause airway compromise and assist in pain control. Fractures should not be fixed until clinicians with the appropriate equipment and training are available due to the risk of causing further damage. This chapter will describe the identification and practical management of PNI and facial fractures in austere and resource-limited environment.
