Diferencia entre revisiones de «Cervical spine clearance»
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===[[C-spine (NEXUS)]] === | ===[[C-spine (NEXUS)]] === | ||
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===Canadian C-spine=== | ===Canadian C-spine=== | ||
Revisión del 22:57 3 sep 2015
Background
- US and Canada with more than 13 million trauma pts per year at risk for C-spine injury
- Most blunt trauma patients will be placed in a cervical collar by EMS to protect the C-spine
- C-spine can be clinically cleared by trained personnel
Clinical Features
C-spine injuries may present with
- rarely neurogenic shock (bradycardia, hypotension)
- posterior neck pain
- pain on palpation of spinous processes
- limited neck ROM with pain
- weakness, numbness, or paresthesias
Decision Rules
C-spine (NEXUS)
NEXUS Cervical Spine Rule
Radiography is not necessary if the patient satisfies ALL of the following low risk criteria:
- No midline cervical tenderness
- No focal neuro deficits
- Normal alertness
- No intoxication
- No painful distracting injury
C-spine imaging should be considered unless the patient meets all of the above low risk criteria[1] [2]
Canadian C-spine
- alert, GCS 15
- not intoxicated
- no distracting injuries
- not a high risk pt (not > 65, no dangerous mechanism, paresthesias)
- any low risk factor present
- sitting position in ED, ambulatory at any time, delayed neck pain, no midline TTP
- able to actively rotate neck 45 degrees bilaterally
C-spine can be cleared clinically if above criteria met[3] [4]
Workup
- if unable to be cleared by NEXUS or Canadian C-spine Rules then imaging is indicated
- CT C-spine noncon or X-rays with odontoid view
- CT better than Xray [5]
- Xrays/CTs not adequate to assess for ligamentous instability
- if pt continues to have midline pain after adequate pain control obtain MRI (can be done outpatient)
- keep C-collar until MRI results or pain resolves
Management
Disposition
- based on imaging results
See Also
External Links
References
- ↑ 27. Hoffman JR, et al. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med 1992;21:1454-60.
- ↑ Mahadevan, et al. Interrater reliability of cervical spine injury criteria inpatients with blunt trauma. Ann Emerg Med1998;31:197-201
- ↑ Stiell IG,et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841-8.
- ↑ Stiell IG, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510-8.
- ↑ Bailitz J, Starr F, Beecroft M, et al. CT should replace three view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009;66:1605e1609.