Neck and Spine Emergencies

Question 1

Head injuries are associated with _____ of all patients with spinal cord injury and need a ___________.

Answer 1

25%; Noncontrast CT

Question 2

How do we treat knife wounds?

Answer 2

Leave impaled objects in place, determine weapon, length, entry mode. Avoid NG or OG tube placement

Question 3

With blunt trauma to the spine what do we always assume?

Answer 3

assume spine injuries until proven otherwise

Question 4

Hypovolemia is more common in what type of spinal injury?

Answer 4

blunt/penetrating trauma (presume until otherwise)

Question 5

How do we treat spinal trauma?

Answer 5

Aim at volume replacement using crystalloid and/or blood

Question 6

How do we test the Spinal accessory nerve?

Answer 6

SCM and trapezius weakness

Question 7

Blunt neck trauma is associated with what other injuries?

Answer 7

Associated w/ tracheal, laryngeal, C-spine trauma. Vessels and esophagus rarely injured.

Question 8

How do we treat bullet wounds?

Answer 8

They have an unpredictable path, thus we evaluate ALL structures: airway, esophagus, vessels, nerves

Question 9

A2BC2def

Answer 9

Airway, Alignment – neck alignment and immobility

Breathing

Circulation, C spine:(shock:hemorrhagic/neurogenic– may need neuropressors)

Disability: neuro exam

Expose the body

Fetus- check if pregnant

Question 10

How do we immobilize the spine? How many people does it take?

Answer 10

long spine board, C collar, log-roll off backboard, maintain in line stabilization.

3

Question 11

AMPLE history:

Answer 11

Allergies, Meds, PMH, Last meal, Events leading up to it

Question 12

NEXUS

Answer 12

1. Posterior midline C-Spine tenderness?
2. Evidence of intoxication?
3. Normal level of alertness?
4. Focal neurological deficit?
5. Painful distracting injuries?

If no to all then no radiograph

Question 13

“Clinically Clearing” a patient

Answer 13

Patients with no neurological deficits and normal spine radiographs are taken off the back board as soon as possible secondary to serious skin breakdown.

The decision to remove a hard cervical collar is easy when the pt is awake and without neuro deficit or neck pain.

Following significant head trauma, if cervical spine radiographs are normal the collar is removed

If pain is significant in flexion and extension the neck is maintained in hard cervical collar until the radiographs can be performed.

Question 14

3 views, patient still in cervical collar:

Answer 14

1. True lateral, including all seven vertebrae and visualization of the C7-T1 junction
2. AP
3. Open-mouth odontoid view

Lateral View is the single most important view to obtain. First view taken, before patient moved

Question 15

Canadian C Spine High Risk Factors Which Mandate Radiography:

Answer 15

Age ≥ 65 years
or
Dangerous mechanism* 
or
Paresthesias in extremities

Question 16

What are considered dangerous mechanisms?

Answer 16

1. fall from elevation ≥ 3 feet / 5 stairs
2. axial load to head, e.g. diving
3. MVC high speed (>100km/hr), rollover, ejection
4. bicycle struck or collision

Question 17

Canadian C Spine Low-Risk Factor Which Allows

Safe Assessment of Range of Motion:

Answer 17

Simple rearend MVC**
or
Sitting position in ED
or
Ambulatory at any time
or
Delayed onset of neck pain***
or
Absence of midline c-spine tenderness

Question 18

Canadian C Spine Evaluation:

Answer 18

No high risk factors, positive low risk and can rotate neck 45 degress.

Question 19

When are the spinal evaluations not applicable?

Answer 19

• Non-trauma cases
• GCS <16 years
• Acute paralysis
• Known vertebral disease
• Previous C-spine surgery

Question 20

What is a Concussion?

Answer 20

aka mTBI “a complex pathophysiologic process affecting the brain, induced by traumatic biomechanical forces secondary to direct or indirect forces to the head; caused by a blow or jolt to the head that disrupts the function of the brain”

Question 21

What are the signs and symptoms of a concussion?

Answer 21

• Associated with normal structural neuroimaging findings
• Physical, cognitive, emotional, and/or sleep-related symptoms
• May or may not be associated with LOC
• Variable duration of symptoms

Question 22

Who is at highest risk for a concussion?

Answer 22

Groups at highest risk: Infants, children (0-4y), Children and young adults (5-24y), Older adults (75y+)

Question 23

What is the most likely etiology of a concussion?

Answer 23

Leading Causes: Falls, MVA, unintentional events, assults, SPORTS

Question 24

How are concussions managed?

Answer 24

Contained in the Acute Concussion Evaluation care plan

Rest and careful management of physical and cognitive exertion are keys

Do not return to high risk activities if sxs exist. When sxs are no longer present, slow, gradual return to daily activities

Question 25

Return to daily/home activities

Answer 25

Increased rest and limited exertion

Delay return to driving, especially if there are any problems with attention, processing, or reaction time

Adequate sleep, including naps or rest breaks

Limit physical and cognitive exertion:
PE, sports, weight training, running; Anything that demands concentration or focus, memory, reasoning, reading, writing (school work, TV)

Question 26

Return to School activities

Answer 26

Monitor the student for problems:

1) in attention or concentration
2) in remembering or learning new information
3) taking longer than necessary to complete tasks
4) with increased symptoms during school work
5) Greater irritability

Until full recovery is made, accommodations for rest, shortened class time, extended time to complete work, reduced assignments may be required

Question 27

Return to Play activities

Answer 27

Never return to sports or recreational activities when any lingering or persistent symptoms exist (Sx free with any physical and cognitive exertion)

The key is a gradual return to play in which coaches should be main person to monitor person when they return to play

Question 28

Return to work activities

Answer 28

Rest from physical and cognitive exertion is key to recovery

Schedule considerations include shortened work day, breaks when symptoms increase, reduced tasks, assignments, and responsibilities

Safety considerations include no driving, no heavy lifting, no working with machinery, no working at heights

Question 29

What is the progression an athlete goes through post concussion to be able to play in a game again?

Answer 29

Rest – aerobic exercise (stationary bike) – sport-specific activity (running) – non-contact drills – full contact controlled training – full contact game