TY - JOUR T1 - Management of a penetrating injury to the carotid artery JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2021-000857 VL - 6 IS - 1 SP - e000857 AU - Sayuri P Jinadasa AU - David V Feliciano Y1 - 2021/11/01 UR - http://tsaco.bmj.com/content/6/1/e000857.abstract N2 - A 59-year-old man presented to the trauma center with multiple stab wounds to his face, neck, chest, abdomen, bilateral arms, and bilateral hands. He did not complain of pain in any specific area of injury.The patient was able to state his name. His systolic blood pressure was 98 mm Hg, heart rate was 107 beats/min, and respiratory rate was 34 breaths/min with audible breath sounds bilaterally. There was a main 1.5 cm stab wound to his left neck posterior to the sternocleidomastoid muscle at the level of the thyroid cartilage. No air was bubbling out of this nor any of his other cervical wounds. In addition, there was no associated bleeding, hematoma, palpable thrill, or audible bruit. His neurologic examination revealed that his Glasgow Coma Scale score was 15, and he did not have any lateralizing signs or focal deficits. His cranial nerve examination was intact. On abdominal examination, he did have tenderness in all four quadrants, but did not have peritonitis. His pulse examination was normal in all four extremities.Which clinical finding would NOT warrant immediate exploration in the operating room?Positive focused abdominal sonogram for trauma (FAST) with hypotensionPulsatile bleeding from the neck woundPeritonitis on abdominal examinationCrepitus on chest palpationAfter blood was drawn for type and cross-match, two large bore intravenous catheters were inserted. A chest X-ray and an extended focused abdominal sonogram for trauma (eFAST) examination were performed. The chest X-ray did not show any abnormalities, and the eFAST was negative.The patient’s repeat systolic blood pressure was 113 mm Hg. Because he had a normal blood pressure, did not have hard signs of a vascular or aerodigestive injury in his neck, and did not have a positive FAST nor peritonitis on abdominal examination, he underwent a CT scan of his abdomen and pelvis with … ER -