390 COMPLICATIONS OF WOUNDS IN THE NECK. 



condition of the wound, as well as by emphysema in the neighbour- 

 hood of the injury. Bloody discharge from the nose, coughing, 

 rattling in the throat, and dyspnoea point to the entrance of a 

 large quantity of blood into the trachea. Where these symptoms 

 occur, the bleeding vessels must be immediately tied and patients 

 with injuries to the trachea, or in its neighbourhood, should not be 

 left unattended. Extravasations in the neck sometimes lead to 

 compression of the trachea and death from suffocation, and, where 

 this threatens, tracheotomy becomes necessary. It is also called 

 for where much blood has entered the lungs. A tampon cannula is 

 inserted, or the trachea plugged above the cannula to prevent the 

 blood passing downwards. In such cases the tracheal tube must 

 be fixed with especial care to prevent the tampons falling into the 

 trachea. For this purpose, and in order to be able to remove the 

 tampon more easily, it is well to encircle it with a piece of tape, which 

 can be fastened round the neck. For further information, refer 

 to the article on tracheotomy. 



(5) Injuries to the oesophagus are not so frequent. They usually 

 occur in the lower third, on the left side of the neck. (Esophageal 

 mischief is shown by the presence of chewed food or saliva in the 

 wound. Though such wounds are not dangerous to life, they require 

 a long time to heal, and are apt to lead to fistula. 



(6) Wounds lower down on the neck, usually produced by the 

 carriage pole, or by running against obstacles, may extend 8 to 12 

 inches deep between the shoulder blade and thorax, and cause 

 extensive destruction of the muscular tissues of the shoulder and 

 breast. They are still more serious when they extend to the first 

 ribs, or the space between them. Complicated fractures of the 

 ribs are often produced in this manner. 



The wound, if confined to the muscular tissue, requires no 

 particular attention, although fatal results occasionally ensue from 

 extensive pus formation, or from infection of the chest. The extent 

 of such injuries is sometimes difficult to ascertain at first, and for 

 a few days diagnosis should be guarded. Where one or another of 

 the ribs is injured, purulent pleuritis and death can seldom be averted. 

 Early and continuous irrigation should be adopted, and the wound 

 in the skin and muscles laid open to allow free exit of discharge. 

 This is even more requisite where the injury extends to the muscular 

 tissue of the breast, and under the shoulder. With free opening 

 and the use of drainage-tubes such wounds, however, usually heal 

 satisfactorily. Injuries involving the sternum are dangerous, because 

 this bone is liable to become necrotic, producing so-called sternal 



