submitted by:thomas morgan ms4 faculty reviewer:sandra oldham m.d. date accepted:30, august 2007...
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Submitted by: Thomas Morgan MS4
Faculty reviewer: Sandra Oldham M.D.
Date accepted: 30, August 2007
Radiological Category: Principal Modality (1):
Principal Modality (2):
Primary Radiographic Survey in a Trauma Patient
Emergency
CT
Plain films
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Case History
• 25 year old male victim of a high speed, head-on MVC w/prolonged extrication
• Restrained driver
• + Loss of consciousness
• Intubated en route, transferred to MHH via Life-Flight
• Assessment by Trauma team revealed:• Tachycardic, normotensive• R hemotympanum, L ear laceration, abnormal but stable pelvis, no
obvious deformity, Glasgow Coma Score (GCS) 3
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Radiological Presentations CXR: 2am
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Radiological PresentationsCRX: 7am
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AP Pelvis
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Radiological Presentations
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Radiological Presentations
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Radiological Presentations
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Clinical:
The NEXUS criteria state that a patient with suspected c-spine injury can be cleared providing the following:
No posterior midline cervical spine tenderness is present. No evidence of intoxication is present. The patient has a normal level of alertness. No focal neurologic deficit is present. The patient does not have a painful distracting injury.
90.7% sensitive for clearing low risk patients without the need for radiographic studies.
Clearing a Cervical Spine Injury
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Radiological (plain films):
Lateral View:-anterior contour line -posterior contour line -spinolaminar contour line
Each of these lines should form a smooth lordotic curve. An exception occurs in young children who may have a benign pseudosubluxation in the upper cervical spine. Check individual vertebrae thoroughly for obvious fracture or changes in bone density.ADI- space between dens and atlas <3mm in adults, 4-5mm in kidsSoft tissue swelling anterior to vertebral bodies
Odontoid View: Important for visualizing the dens (C2) and looking at the symmetry between the dens and the lateral masses of C1. Can also see if the spinous processes are midline
Clearing a Cervical Spine Injury
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Coronal and Sagittal Views
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CT Neck
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Radiological Presentations
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Radiological Presentations
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Radiological Presentations
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Radiological Presentations
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Radiological Presentations
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•Admitted to STICU
– L chest tube and ventilator support
– Neurosurgery followed traumatic brain injury with bolt ICP monitor, but did not operate
– Orthopedics followed but did not operate
– Course complicated by pneumonia and SIADH
– Neurological status improved minimally
– Transferred to Long term care facility
Hospital Course
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1. Cervical Spine Injuries. May 11th 2006. Jorma B. Mueller. Emedicine.com
2. American Academy of Family Physicians. Cervical Fractures Vol. 52/No. 2 (Jan. 15 1999). Mark. A. Graber MD, Mary Kathol MD
3. Special Thanks to: Dr. Sitton, John Larkin MS4
References