C-Spine

Question 1

C-Spine Injury

ASAP:

Answer 1

ABCs, IVs, O2, monitor, VS, C-collar, full primary survey

Question 2

C-Spine Injury

Hx/exam:

Answer 2

Pain OPQRST, mxm of injury, weakness, numbness, paresthesias; detailed MSK & neuro ex, full secondary survey

Question 3

C-Spine Injury

Labs:

Answer 3

CBC, BUN/Cr, lytes, gluc, EtOH, others PRN

Question 4

C-Spine Injury

Rads:  

Answer 4

C-spine XR or CT, MRI if suspect ligamentous injury with instability

Question 5

C-Spine Injury

If neurogenic shock…

Answer 5

(due to cervical or high thoracic spinal cord injury): IVF, consult NS. Pressors prn.

Question 6

C-Spine Injury

On XR (AP, lat, odontoid) look for…

Answer 6

Adequate films? (must see top of T1), Ant & post vertebral lines, Spinous line, Vert body & processes uniform ht/alignment, Prevertebral soft tissue <7@C2 & <22@C7, spacing of dens and lateral masses.

Question 7

C-Spine Injury

OK to clear C-spine clinically if…

Answer 7

No sensory deficit, no AMS, no distracting injury, no midline TTP, no drugs/EtOH (SAD MD)

Question 8

C-Spine Injury

If unsure…

Answer 8

C-spine CT or MRI (for occult bony injury or ligamentous injury)

Question 9

C-Spine Injury

If fx or neuro deficits…

Answer 9

Call NS

Question 10

C-Spine Injury

NEXUS:

Answer 10

Focal neuro deficit, midline spinal tenderness, AMS, intoxication, distracting injury