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17 - Cervical spine injury: assessment in trauma

from Section 5 - Orthopaedic surgery

Published online by Cambridge University Press:  05 July 2015

James Pegrum
Affiliation:
University of London Sports & Exercise Department, London, UK
Chris Lavy
Affiliation:
University of Oxford, Oxford, UK
Petrut Gogalniceanu
Affiliation:
Specialist Registrar, General and Vascular Surgery, London Deanery
James Pegrum
Affiliation:
Orthopaedic Registrar, Oxford Deanery
William Lynn
Affiliation:
Specialist Registrar, General Surgery, North East Thames
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Summary

Rules

  1. • All trauma patients have a C-spine injury until proven otherwise.

  2. • Patient's neck can be cleared by radiographic or clinical means.

Clinical clearance requires:

1. No high-risk factors regarding the injury, such as:

  1. a. diving or axial injury

  2. b. fall from height >3 feet (90 cm)/five steps

  3. c. high-speed car collision >60 mph (97 km/h)

  4. d. bike or recreational vehicle collision

2. No high-risk factors regarding the patient:

  1. a. age >65 or <16

  2. b. intoxicated or altered mental status

  3. c. GCS <15

  4. d. abnormal neurology

  5. e. no distracting injuries

  6. f. midline cervical tenderness

Clinical clearance system

1. Completion of ATLS primary survey.

2. History regarding the event and evaluation of the patient for risk factors.

3. Assessment for the presence of distracting injuries (presence of distracting injuries requires cervical imaging).

4. Full neurological examination.

5. In-line immobilisation of C-spine and removal of collar.

6. Second assessor palpates cervical spine. If there is no pain the patient is then asked to actively rotate the head left and right.

7. If there is still no neck pain or numbness/tingling in the limbs the cervical spine can be cleared without radiographic evaluation.

Radiographic clearance system

• Cervical spine radiographs (See Chapter 49, Cervical spine x-ray):

• AP and lateral views.

• All C1–7 and superior aspect of T1 vertebrae must be visualised.

• Swimmer's view or traction on arms (if traumatic injury permits) are needed if standard views are inadequate.

• Current recommendations are for computed tomography (CT) imaging.

Type
Chapter
Information
Physical Examination for Surgeons
An Aid to the MRCS OSCE
, pp. 138 - 139
Publisher: Cambridge University Press
Print publication year: 2015

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