C-spine examinations Flashcards
subjective hx and system review
- determine trauma or instability or vasculogenic disease
- vasculogenic screen + suspicion referral vascular specialist
- upper c-spine screen + referral to ED or physcian
systems to be looking at
cardio-pulm
integumentary
msk
neuromuscular
communication, cognition,
language and learning
patient considerations
- any presence of frank vascular pathologies
- s/s of suspected pathologies
- predisposition to vascular pathologies of the neck
- risk factors of neuro-vascular pathology
risk factors of dissecting stroke
- recent trauma
- vascular anomaly
- current or past smoker
symptoms of dissecting stroke
- headache
- neck pain
- visual distrubances
- paresthesia (upper limb, lower limb)
- dizziness
signs of dissecting stroke
- unsteadiness
- ptosis
- weakness
- facial palsy
- speech difficulties
- swallowing difficulties
- N/V
- dizziness
- drowsiness
- LOC
- confusion
risk factors of non-dissecting stroke
- current or past smoker
- hypertension
- high cholestrol
symptoms of non-dissecting stroke
- headache
- paresthesia (UE and LE)
- visual distrubances
- neck pain
- dizziness
signs of non-dissecting stroke
- weakness
- speech difficulties
- ptosis
- facial palsy
- unsteadiness
- confusion
- vomiting
- swallowing difficulties
- LOC
- drowsiness
considerations for physical exams
no single test alone will provide decision-making information
- positional testing is unlikely to influence decision making
C-spine canadian C-spine rule population
applicable for alert and stable pt’s only
high risk factors that mandate radiography
Canadian c-spine rule
age over 65 or dangerous mechanism or parestheias in extremities
Low risk factor which allow safe assessment of ROM
Canadaian c-spine rule
simple rear-end MVC
sitting position in ED
ambulatory at any time
delayed onset of neck pain
absence of midline c-spine tenderness
no radiograph
Able to actively rotate the neck 45 left and right
Canadian C-spine rule
able = no radiograph
unable = radiograph
dangerous mechanism
Canadian C-spine rule
fall from elevation > 3 feet / 5 stairs
axial load to head
MVC speed over 100
motorized recreational vehicles
bike accidents
~ 60mph
simple rear-end MVC excludes
Canadian C-spine rule
pushed into traffic
hit by a bus / large truck
rollover
hit by high speed vehicle
when is the upper cervical screening exam allowed if there is trauma or concerns of instability or vasculogenic disease?
- if x-rays are clear
- if no x-ray taken, then if pt cleared by canadian CS rules
not allowed if rotation is less than 45deg in 1 direction OR massive splinting entire neck that wont allow motion
negative results from c-spine exam
- vasculogenic risk assessment
pos = vascular MD
neg = screen for #2 - upper cervical screen in order of least to most provocative test
pos = refer to ED or contact MD for advice
neg = continue with CS exam
rotation being primary limitations
upper cervical biomechanical (traditional) exam
side bending being primary limitations
cervical exam (traditional and/or biomechanical)
pt complaints in hx
dizziness
visual disturbances (diplopia, nystagumus)
numbness
ataxia
drop attacks (fainting)
cervical myelopathy (gait problems, tendency to stumble/fall)
radiculopathy
amnesia
trouble concentrating and staying alert
general neck stiffness
deafness
dysarthria
dysphagia
tinnitus
yes response to patient sx hx
any yes response NEEDS a follow up questions until the complaint is known and managed by MD or able to be explained
if not, action is needed!
cervical myelopathy
red flag screening
sensory distrubances of the hands
hypertrophy of intrinsic hand muscles
unsteady gait
Hoffman’s reflex
hyperreflexia
bowel and bladder distrubances
multisegmental weakness and/or sensory changes
neoplastic conditions
red flag screening
previous hx of cancer
unexplained weight loss
constant pain, no relief with bed rest
night pain
over 50 y/o
