By Blair Westerly, MD. Patients requiring prolonged mechanical ventilation linger in. Spinal Trauma - Crashing Patient. Spinal Immobilizationfrom trauma professional! I recommend sliding it out when they are logrolled to examine the back. The board is of little or no benefit to spine stability in a cooperative patient. ![]()
And we have ways of encouraging cooperation if they are not. Reference: How Much Time Does it Take to Get a Pressure Ulcer? Integrated Evidence from Human, Animal, and In Vitro Studies. Ostomy Wound Management. Back to top. Spinal Injuries. Dermatome Map and Reflexes from M Lin. ![]() SURGICAL OPERATIONS: surgery is the branch of medicine that treats diseases, injuries, and deformities by manual or operative methods (click here for main in. From millions of real job salary data. Average salary is Detailed starting salary, median salary, pay scale, bonus data report. Cervical Spine. Back to top. Clinical Decision Rules. Canadian C- Spine Rules (NEJM 2. Annals EM 2. 00. 3; 4. For patients with trauma who are alert (as indicated by a score of 1. Glasgow Coma Scale) and in stable condition and in whom cervical- spine injury is a concern, the determination of risk factors guides the use of cervical- spine radiography. A dangerous mechanism is considered to be a fall from an elevation 3 ft or 5 stairs; an axial load to the head (e. A simple rear- end motor vehicle collision excludes being pushed into oncoming traffic, being hit by a bus or a large truck, a rollover, and being hit by a high- speed vehicle. CONCLUSIONS: In older patients, several CCR criteria, particularly “Dangerous Mechanism”, perform less well and the overall sensitivity of the CCR is insufficient. The “Age 6. 5” criterion remains an important component of the CCR and all potential neck injury patients aged 6. Ann Emerg Med. 2. Apr; 4. 3(4): 5. 07- 1. Retrospective application of the NEXUS low- risk criteria for cervical spine radiography in Canadian emergency departments. N Engl J Med. 2. 00. Dec 2. 5; 3. 49(2. Nexus C- Spine Rules(Ann Emerg Med 1. Actual Nexus Study. No midline tenderness. No pain with neck movement. No distracting injury. No Neurodeficit. No Alcohol or Drugs. No Altered Mental Status. Validated in elderly (have a higher prevalence of odontoid fx) (Ann Emerg Med 4. Validated in Peds > 9 y/o (greater prevalence of lower vertebral c- spine fx) (Pediatrics 1. Hoffman explains the difference in specificity between the two rules b/c NEXUS incorporated the fact that a good portion of the patients would not even be entered b/c nexus ideas has already been integrated. Only patients who you would have gotten an x- ray would have entered the spec. Ex If we created a rule with 1. Once the rule becomes common practice, Only 1. CCR which enrolled all patients. Only included patients who got an x- ray. What is a Distracting Injury (Acad Emerg Medicine 2. NEXUS had a distracting, painful injury (DPI) as their only criteria for the need for radiography. Long Bone Fracture (Most common DPI)Visceral Injury Necessitating surgical consultation. Large laceration, degloving injury, or crush injury. Large Burns. Any injury producing acute functional impairment. One study would indicate that any fracture can be a distracting injury for vertebral injury detection (JEM 2. Another study states that only upper torso injuries are distracting (J Trauma 2. Note on the Normal Mental Status Section: An altered level of alertness can include any of the following: a) Glasgow Coma Scale of 1. Trauma study which challenges the nexus results with ct scan as the gold standardmissed 7 fractures in on- intox, gcs 1. J Trauma 2. 00. 7; 6. Nexus doesn’t seem accurate in sick trauma patients (J Trauma. Altogether 1. 19. CT evaluation of the cervical spine. Cervical injuries were identified in 1. Both methods successfully identified the injury in 7. The remaining 4. 1 (3. CT scan. The authors conclude that CT scan in a trauma patient population identified more bony injuries in the cervical spine than standard conventional radiographs. More importantly, all injuries missed by cervical spine radiographs required treatment. The authors therefore suggest that there does not seem to be any role for cervical spine radiography in the clearance of blunt cervical spine injury. The data from this study have led to an adjustment in practice protocol at the authors. However, such a protocol needs to be prospectively validated before it becomes universal practice. Griffen MM, Frykberg ER, Kerwin AJ, et al. Radiographic clearance of blunt cervical spine injury: plain radiograph or computed tomography scan. Oct; 5. 1(4): 6. 63- 8; discussion 6. Related Articles, Links Prospective comparison of admission computed tomographic scan and plain films of the upper cervical spine in trauma patients with altered mental status. Schenarts PJ, Diaz J, Kaiser C, Carrillo Y, Eddy V, Morris JA Jr. CT is cheaper (1. Blackmore CC, Ramsey ST, Mann FA, Deyo RA (1. Cervical spine screening with CT in trauma patients: a cost- effectiveness analysis. Sixty- one patients had a cervical spine injury and 3. CT scanning had a sensitivity of 9. There were no missed unstable injuries. In contrast, an adequate lateral cervical spine film detected only 2. There is insufficient evidence to suggest that cervical spine CT should replace plain radiography as the initial screening test for less injured patients who are at low risk for cervical spine injury but still require a screening radiographic examination. Cervical spine evaluation in urban trauma centers: lowering institutional costs and complications through helical CT scan. J Am Coll Surg 2. This article basically echoes the findings of the several above. It compared helical CT scan with plain radiography in the initial radiographic evaluation of the cervical spine in moderate to high- risk patients with trauma. The conclusion of the study was that helical CT scan is the preferred initial screening test for the detection for cervical spine fractures among moderate- to high- risk patients seen in urban trauma centers. The authors found that the use of CT to evaluate the cervical spine was more sensitive, more accurate, and more cost- effective. The initial evaluation of the cervical spine in patients of high to moderate risk of cervical spine fracture should be performed by helical CT rather than by plain films. Grogan EL, Morris JA, Dittus RS, et al. Cervical spine evaluation in urban trauma centers: lowering institutional costs and complications through helical CT scan. J Am Coll Surg 2. This article basically echoes the findings of the several above. It compared helical CT scan with plain radiography in the initial radiographic evaluation of the cervical spine in moderate to high- risk patients with trauma. The conclusion of the study was that helical CT scan is the preferred initial screening test for the detection for cervical spine fractures among moderate- to high- risk patients seen in urban trauma centers. The authors found that the use of CT to evaluate the cervical spine was more sensitive, more accurate, and more cost- effective. The initial evaluation of the cervical spine in patients of high to moderate risk of cervical spine fracture should be performed by helical CT rather than by plain films. Latest study(J Trauma 2. The C2 spinous process base (Green dot in Figure 9 below) should not be displaced more than 2 mm from this line. This space should be no more than 3 mm in an adult and 5 mm in a child. Predental Space. Adult < 3mm Child < 5mm. Back to top. Fractures. Width of canal is 1. Ligameta Flava is the posterior margin of the canal. Unstable Fractures. Jefferson Bit Off A Hangman. Generally, fractures are considered to be clinically insignificant if failing to identify them would be unlikely to result in harm to the patient or, alternatively, recognizing the injury would prompt no specific treatment. Two groups have categorized, by expert consensus, a number of injuries as not clinically important. The National Emergency X- Radiography Utilization Study (NEXUS) group identified the following injuries as not clinically significant: spinous process fractures, wedge compression fractures with loss of 2. Similarly, the Canadian CT Head and Cervical Spine Study group identified the following injuries as not significant: simple osteophyte fractures, transverse process fractures, spinous process fractures, and compression fractures with loss of less than 2. Clay Shoveler. Prevertebral swelling over 7mm at C3 is non- specific, and seen in about 5. AOD. Note the basion- dens interval (a) and the posterior axial line, which is drawn along the posterior cortex of the axis (b). Harris criteria for the diagnosis of AOD: (1) Basion to dens interval > 1. Basion to posterior dens tip > 1. Cross- table lateral radiograph shows atlanto- occipital dislocation with a basion- dens interval of 2. C1 Atlas Fractures. Isolated fractures of the atlas are rare and divided into three types (5). C2 Axis Fractures. Fractures of the axis are also divided into three types (7). The dens fracture is the most common form and has four subtypes: I (dens tip), II (dens base), IIa (dens base with comminution), III (dens plus body of C- 2). Type C fractures are rare and respond well to external immobilization. Type I dens fracture Type II dens fracture . The least common fracture pattern is the C1- Hangman. Subaxial Fractures. The stability of C3 . Figure displaying 3- column theory of Denis (A) Anterior column (B). A bilateral facet dislocation results from extreme flexion which causes the inferior articular facet of the upper vertebra to pass over the super articular facet of the lower vertebra. The flexion teardrop is a fracture of the inferior- anterior portion of a vertebral body. A unilateral facet dislocation may be diagnosed if one lateral mass is more anterior than the other. In this case, the lines will be less dense since the lateral masses are not superimposed anymore (see arrows). Extension. The Hangman. The extension teardrop fracture is radiographically similar to the flexion teardrop fracture, involving the anterior- inferior portion of a vertebral body. A compression fracture of a vertebral body usually responds well to external immobilization. Recent evidence suggests adults present with SCIWORA at an incidence higher than previously thought. Treatment is based on MRI findings.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
September 2017
Categories |