cervical spine injuries assessment and early management
TRANSCRIPT
Cervical spine injuries
Assessment and early management
A Dismal Image
• Cord injury not treatable still
• Unpredictable outcome
• Prolonged course of treatment
• Psychosocial factors
Commonest and most devastating injury of axial skeletonCommonest and most devastating injury of axial skeleton
Spinal cord injuries
• Constitute 2-5 % OF all blunt trauma • 40-50 cases / million • 40 % of cervical spine injuries have
cord involvement • Cost factor
Initial management
steps• Haemodynamic
stabilization• Cervical collar• X-ray • CT scan • MRI• Steroids
• Traction• Secondary
exam
• ICU admission • Prevention of
DVT
• Physiotherapy
Initial management steps
Eratic practice
• Variations • Cross table xray• Unconcious pt• high resolution imaging • cost and morbidity
Guide lines
• British trauma society working party
immobilization
• Critera for risk• Teqnique• Spine boards• Log rolling• Transfer slides
Special circumstances
• Neck not neutral• Unco-operative pt• Vomiting• Intubation• Transfer to another hospital
Exclusion criteriaclinical
• Alertness• Head injury• No alcohol or drugs• No neck pain• No neurology• No distracting injury
Plain xrays
• Ap• Lateral• open mouth• Oblique• Other views
Ct scan
• Targeted 2-3 mm• Whole • multi slice ct
Mri scan
• Ligaments ,disc and neural tissue • In unconciuos pts
Dynamic studies
• Flexion and extension xrays • Or fluroscopy
Unconcious
• In line immobilization• Mri• Dynamic • Ct
Aalgorithm