2 - head and neck Flashcards
You will have unopposed parasympathetic tone if traumatic injury has occurred at or above what spinal level?
T6
ABC’s of head trauma
airway alignment breathing circulation cspine disability exposure fetus
“AMPLE”
take an ample hx allergies meds PMH last meal events
what dx test is best for head injury?
CT w/out
when is a head CT warranted?
AMS
sz
focal neuro deficit
pain, temp, and crude touch
spinothalamic
fine touch, vibration, proprioception
posterior column
Impaired gag reflex or pupillary reflex indicates what?
these are brain stem reflexes, suspect high c-spine injury
what GI complaint is common after spinal trauma?
ileus
what’s the first imaging test to order in cspine injury?
xray….usually catches injury. (But can’t r/o injury)
What view do you get to visualize T1?
swimmer’s view
Get an xray of cspine in presence of what factors?
1) bone tenderness
2) intoxication
3) AMS
4) neuro def
5) distracting injuries
6) age >65
7) fall from height
8) axial load to head
9) rollover/ejection from MVA/bike
When can you skip cspine xray?
Neck pain in pt under 65 AND:
1) simple MVA
2) sitting up on exam
3) ambulatory
4) delayed onset of pain
5) perispinal (muscle pain)
6) able to flex/extend/rotate head
How do you clear a spinal injury?
1) assess for neuro deficits
2) remove collar and manually stabilize neck
3) assess subjective complaints
4) palpate midline and lateral neck for pain
5) If non-tender, have pt actively flex and extend head
6) If non-tender, have pt actively rotate.
7) if ANY finding is abnormal, stop then, replace ccollar, get CT
prevertebral soft tissue should be no greater than ____mm at C3, and no greater than ___mm at C7. If it is larger, what do you suspect?
7mm, 21mm, suspect edema, assess and protect airway
What does muscle spasm in the neck look like on xray?
loss of the normal lordotic curvature
axial load injuries are likely to cause what type of fracture?
Jefferson–C1
severe whiplash or other hyperextension injuries of the neck are likely to cause what type of fx?
Hangman–C2
Flexion injuries of the neck are likely to cause what type of fx?
Teardrop–C4-C6
teardrop shaped fragment of the anterio-inferior vertebrae
If you see a teardrop fx, what should you also expect?
neuro injury due to compromise of ligaments
Neck injury caused by shear force of back muscles pulling on spine base
Clay shoveler’s Fx, (avulsion) at C7
this is a serious neck injury that does not involve a fracture. Cause is flexion. Ex: head on MVA
atlantoaxial subluxation
Momma had a baby and it’s head popped off. Common in kids, separation b/t C1 and skull.
Atlanto-occipital dislocation
Obvious misalignment of the vertebrae with no fx. STEP OFF
facet dislocation
