Neck and Spinal Trauma

Question 1

What are the signs of an aerodigestive injury?

Answer 1

Drooling
Stridor
Subcut emphysema
Creptius over the larynx/cricoid
Dys/Aphonia
Gurgling from wound

Question 2

What are the signs of a neck vascular injury?

Answer 2

Hard
- Pulsatile haematoma
- Expanding haematoma
- Carotid bruit/thrill
- Stroke syndrome
- Pulsatile bleeding from wound
- Distal pulse deficit (ie temporal arteries)
- Massive haemoptysis or haematemesis

Soft
- Minor haemoptysis or haematemesis
- Oropharynx minor bleeding
- Non-expanding/pulsatile haematoma

Question 3

What is the most commonly missed injury in penetrating neck trauma?

Answer 3

Oesophageal injury, only 50% sensitive with CT neck
A common cause of delayed mortality

Question 4

What CT scan is usually ordered with penetrating neck trauma?

Answer 4

CT angiogram of neck +/- chest

Question 5

What are the main atypical spinal cord syndromes and how do they present?

Answer 5

Anterior Cord
- Complete paralysis below lesion + loss of pain and temp sensation
- Intact posterior columns including vibration and proprioception
- Poor prognosis

Central cord Syndrome
- Upper > Lower limb quadriparesis and loss of pain/temp sensation
- Good prognosis

Brown-Sequard Syndrome
- Ipsilateral loss paresis and loss of proprioception/vibration
- Contralateral loss of pain and temperature, these tracts cross the midline

Question 6

What is the AAST TL spine decision clinical rule?

Answer 6

Used to clear the T/L spine if no to all points

• Age >60?
• Intoxicated/altered consciousness?
• Pain/deformity/tenderness to the T/L spine?
• High risk mechanism? (high speed MVA, fall from height, ped v car, ejection from vehicle, crush injury)