<br /> Penetrating neck injuries in children are rare—but when they happen, the stakes are high. In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast, we explore the clinical pearls behind “no-zone” management, how to distinguish hard and soft signs, when to image versus operate, and why airway always comes first. Get ready for a focused, evidence-based deep dive into pediatric neck trauma.<br /> <br /> <br /> <br /> Learning Objectives<br /> <br /> <br /> <br /> <br /> * Understand the shift from zone-based to “no-zone” management in pediatric penetrating neck injuries and describe the rationale behind this transition.<br /> <br /> <br /> <br /> * Apply ATLS principles to the initial assessment and stabilization of children with penetrating neck injuries, including decisions regarding imaging and airway management.<br /> <br /> <br /> <br /> * Evaluate clinical findings to determine the need for operative intervention versus observation in stable pediatric patients with soft versus hard signs of vascular or aerodigestive injury.<br /> <br /> <br /> <br /> <br /> Connect with Brad Sobolewski<br /> <br /> <br /> <br /> <br /> * PEMBlog: <a href="https://www.pemblog.com/">PEMBlog.com</a><br /> <br /> <br /> <br /> * Blue Sky: <a href="https://bsky.app/profile/bradsobo.bsky.social">@bradsobo</a><br /> <br /> <br /> <br /> * X (Twitter): <a href="https://twitter.com/PEMTweets">@PEMTweets</a><br /> <br /> <br /> <br /> * Instagram: <a href="https://www.instagram.com/bradsobolewski/">Brad Sobolewski</a><br /> <br /> <br /> <br /> * Mastodon: <a href="https://med-mastodon.com/@bradsobo">@bradsobo@med-mastodon.com</a><br /> <br /> <br /> <br /> <br /> References<br /> <br /> <br /> <br /> Stone ME Jr, Christensen P, Craig S, Rosengart M. Management of penetrating neck injury in children: A review of the National Trauma Data Bank. Red Cross Annals. 2017;32(4):171–177. doi:10.1016/j.rcsann.2017.04.003<br /> <br /> <br /> <br /> Callcut RA, Inaba K. Penetrating neck injuries: Initial evaluation and management. UpToDate. Waltham, MA: UpToDate Inc. [Accessed June 24, 2025]. Available from: https://www.uptodate.com<br /> <br /> <br /> <br /> Transcript<br /> <br /> <br /> <br /> Note: This transcript was partially completed with the use of the Descript AI and the Chat GPT 4o AI<br /> <br /> <br /> <br /> Welcome to PEM Currents: The Pediatric Emergency Medicine Podcast. As always, I’m your host, Brad Sobolewski, and in this episode we are diving into a high-stakes but fortunately rare topic in pediatric trauma — penetrating neck injuries. Now these injuries make up less than 1% of all pediatric trauma, but when they occur, they demand precision and vigilance in terms of diagnosis and management.<br /> <br /> <br /> <br /> As you know, the neck packs some vital organs, vessels, the airway, esophagus, and nerves into a tiny little area, so even a seemingly minor wound can injure multiple structures.<br /> <br /> <br /> <br /> Now you remember — way back when — where you learned about the zones of the neck, and this is the traditional teaching, which chopped the neck up into three zones.<br /> <br /> <br /> <br /> You’ve got Zone I, which is the area between the clavicle and cricoid. You’ve got the subclavian arteries and vein, the carotid, and the apices of the lungs.Zone II, the cricoid to the angle of the mandible — this includes the c