Flashcards in Neck and Spine Emergencies Deck (29):
Head injuries are associated with _____ of all patients with spinal cord injury and need a ___________.
25%; Noncontrast CT
How do we treat knife wounds?
Leave impaled objects in place, determine weapon, length, entry mode. Avoid NG or OG tube placement
With blunt trauma to the spine what do we always assume?
assume spine injuries until proven otherwise
Hypovolemia is more common in what type of spinal injury?
blunt/penetrating trauma (presume until otherwise)
How do we treat spinal trauma?
Aim at volume replacement using crystalloid and/or blood
How do we test the Spinal accessory nerve?
SCM and trapezius weakness
Blunt neck trauma is associated with what other injuries?
Associated w/ tracheal, laryngeal, C-spine trauma. Vessels and esophagus rarely injured.
How do we treat bullet wounds?
They have an unpredictable path, thus we evaluate ALL structures: airway, esophagus, vessels, nerves
Airway, Alignment – neck alignment and immobility
Circulation, C spine:(shock:hemorrhagic/neurogenic– may need neuropressors)
Disability: neuro exam
Expose the body
Fetus- check if pregnant
How do we immobilize the spine? How many people does it take?
long spine board, C collar, log-roll off backboard, maintain in line stabilization.
Allergies, Meds, PMH, Last meal, Events leading up to it
1. Posterior midline C-Spine tenderness?
2. Evidence of intoxication?
3. Normal level of alertness?
4. Focal neurological deficit?
5. Painful distracting injuries?
If no to all then no radiograph
"Clinically Clearing" a patient
Patients with no neurological deficits and normal spine radiographs are taken off the back board as soon as possible secondary to serious skin breakdown.
The decision to remove a hard cervical collar is easy when the pt is awake and without neuro deficit or neck pain.
Following significant head trauma, if cervical spine radiographs are normal the collar is removed
If pain is significant in flexion and extension the neck is maintained in hard cervical collar until the radiographs can be performed.
3 views, patient still in cervical collar:
1. True lateral, including all seven vertebrae and visualization of the C7-T1 junction
3. Open-mouth odontoid view
Lateral View is the single most important view to obtain. First view taken, before patient moved
Canadian C Spine High Risk Factors Which Mandate Radiography:
Age ≥ 65 years
Paresthesias in extremities
What are considered dangerous mechanisms?
1. fall from elevation ≥ 3 feet / 5 stairs
2. axial load to head, e.g. diving
3. MVC high speed (>100km/hr), rollover, ejection
4. bicycle struck or collision
Canadian C Spine Low-Risk Factor Which Allows
Safe Assessment of Range of Motion:
Simple rearend MVC**
Sitting position in ED
Ambulatory at any time
Delayed onset of neck pain***
Absence of midline c-spine tenderness
Canadian C Spine Evaluation:
No high risk factors, positive low risk and can rotate neck 45 degress.
When are the spinal evaluations not applicable?
- Non-trauma cases
- GCS <16 years
- Acute paralysis
- Known vertebral disease
- Previous C-spine surgery
What is a Concussion?
aka mTBI “a complex pathophysiologic process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head; caused by a blow or jolt to the head that disrupts the function of the brain”
What are the signs and symptoms of a concussion?
- Associated with normal structural neuroimaging findings
- Physical, cognitive, emotional, and/or sleep-related symptoms
- May or may not be associated with LOC
- Variable duration of symptoms
Who is at highest risk for a concussion?
Groups at highest risk: Infants, children (0-4y), Children and young adults (5-24y), Older adults (75y+)
What is the most likely etiology of a concussion?
Leading Causes: Falls, MVA, unintentional events, assults, SPORTS
How are concussions managed?
Contained in the Acute Concussion Evaluation care plan
Rest and careful management of physical and cognitive exertion are keys
Do not return to high risk activities if sxs exist. When sxs are no longer present, slow, gradual return to daily activities
Return to daily/home activities
Increased rest and limited exertion
Delay return to driving, especially if there are any problems with attention, processing, or reaction time
Adequate sleep, including naps or rest breaks
Limit physical and cognitive exertion:
PE, sports, weight training, running; Anything that demands concentration or focus, memory, reasoning, reading, writing (school work, TV)
Return to School activities
Monitor the student for problems:
1) in attention or concentration
2) in remembering or learning new information
3) taking longer than necessary to complete tasks
4) with increased symptoms during school work
5) Greater irritability
Until full recovery is made, accommodations for rest, shortened class time, extended time to complete work, reduced assignments may be required
Return to Play activities
Never return to sports or recreational activities when any lingering or persistent symptoms exist (Sx free with any physical and cognitive exertion)
The key is a gradual return to play in which coaches should be main person to monitor person when they return to play
Return to work activities
Rest from physical and cognitive exertion is key to recovery
Schedule considerations include shortened work day, breaks when symptoms increase, reduced tasks, assignments, and responsibilities
Safety considerations include no driving, no heavy lifting, no working with machinery, no working at heights