Blunt neck trauma: Difference between revisions
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==Background== | ==Background== | ||
*Suspect vascular damage to cord if discrepancy between [[Focal neurologic deficits|neuro deficit]] and level of spinal column injury | |||
*[[Spinal cord injury]] is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted | |||
[[File:Three-column-concept-2.jpg|thumb|Three column concept of spinal fracture stability]] | [[File:Three-column-concept-2.jpg|thumb|Three column concept of spinal fracture stability]] | ||
== | ==Clinical Features== | ||
{{ | *Signs of life-threatening neck or upper thoracic injury (look for ''TWELVE'') | ||
''T''racheal deviation'', | |||
''W''ounds, | |||
''E''xternal markings, | |||
''L''aryngeal disruption, | |||
''V''enous distention, | |||
''E''mphysema (surgical) | |||
*Features may include signs and symptoms of: | |||
**[[Spinal cord injury]] | |||
**[[Vertebral and Carotid Artery Dissection]] | |||
**Laryngeal or [[tracheal injury]] | |||
==Differential Diagnosis== | |||
{{Blunt neck trauma DDX}} | |||
===Other=== | |||
*[[Head trauma]] | |||
*[[Thoracic trauma]] | |||
==Evaluation== | |||
===Fracture=== | |||
{{C-spine NEXUS}} | |||
:^If find injury consider CT C-spine, x-ray rest of spine | |||
===[[Spinal cord trauma]]=== | |||
*Neuro exam | |||
===[[Vertebral and Carotid Artery Dissection]]=== | |||
{{Denver Screening Criteria}} | |||
== | ===Pediatrics=== | ||
* | *In a small study of 42 patients with a cervical seatbelt sign there were no isolated cerebrovascular injuries. For pediatric patients in a motor vehicle collision, the presence of an isolated seatbelt sign was not associated with any cases of cerebrovascular injury. <ref>Desai NK, et al. Screening CT angiography for pediatric blunt cerebrovascular injury with emphasis on the cervical “seat- belt sign.” AJNR Am J Neuroradiol. 2014 Sep;35(9):1836-40. PMID: 24722311.</ref> | ||
==Management== | ==Management== | ||
*Prehospital | *Prehospital | ||
**See the [[EBQ:Prehospital Spine Immobilization|NAEMSP National Guidelines for Spinal Immobilization]] | |||
*Hospital | |||
**Secure ABCs | |||
**See specific diagnosis | |||
==Disposition== | |||
*Based on specific diagnosis | |||
==See Also== | ==See Also== | ||
*[[ | *[[Penetrating neck trauma]] | ||
*[[ | *[[Cervical spine clearance]] | ||
*[[ | *[[Canadian cervical spine rule]] | ||
*[[ | *[[NEXUS cervical spine rule]] | ||
== | ==References== | ||
<references/> | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category: | [[Category:Orthopedics]] |
Revision as of 16:11, 13 April 2017
Background
- Suspect vascular damage to cord if discrepancy between neuro deficit and level of spinal column injury
- Spinal cord injury is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted
Clinical Features
- Signs of life-threatening neck or upper thoracic injury (look for TWELVE)
Tracheal deviation, Wounds, External markings, Laryngeal disruption, Venous distention, Emphysema (surgical)
- Features may include signs and symptoms of:
Differential Diagnosis
Neck Trauma
- Penetrating neck trauma
- Blunt neck trauma
- Cervical injury
- Neurogenic shock
- Spinal cord injury
Other
Evaluation
Fracture
NEXUS Cervical Spine Rule
Radiography is not necessary if the patient satisfies ALL of the following low risk criteria:
- No midline cervical tenderness
- No focal neuro deficits
- Normal alertness
- No intoxication
- No painful distracting injury
C-spine imaging should be considered unless the patient meets all of the above low risk criteria[1] [2]
- ^If find injury consider CT C-spine, x-ray rest of spine
Spinal cord trauma
- Neuro exam
Vertebral and Carotid Artery Dissection
Denver screening criteria for blunt cerebrovascular injury
The Denver Screening Criteria are divided into risk factors and signs and symptoms
Signs and Symptoms
- Arterial hemorrhage
- Cervical bruit
- Expanding neck hematoma
- Focal neurologic deficit
- Neuro exam inconsistent with head CT
- Stroke on head CT
Risk Factors
- Midface Fractures (Le Fort II or III)
- Basilar Skull Fracture with carotid canal involvement
- Diffuse axonal injury with GCS<6
- Cervical spine fracture
- Hanging with anoxic brain injury
- Seat belt abrasion or other soft tissue injury of the anterior neck resulting in significant swelling or altered mental status
Pediatrics
- In a small study of 42 patients with a cervical seatbelt sign there were no isolated cerebrovascular injuries. For pediatric patients in a motor vehicle collision, the presence of an isolated seatbelt sign was not associated with any cases of cerebrovascular injury. [6]
Management
- Prehospital
- Hospital
- Secure ABCs
- See specific diagnosis
Disposition
- Based on specific diagnosis
See Also
- Penetrating neck trauma
- Cervical spine clearance
- Canadian cervical spine rule
- NEXUS cervical spine rule
References
- ↑ 27. Hoffman JR, et al. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study. Ann Emerg Med 1992;21:1454-60.
- ↑ Mahadevan, et al. Interrater reliability of cervical spine injury criteria inpatients with blunt trauma. Ann Emerg Med1998;31:197-201
- ↑ DiPerna CA, Rowe VL, Terramani TT, et al. Clinical importance of the “seat belt sign” in blunt trauma to the neck. Am Surg. 2002;68:441–445
- ↑ Rozycki GS, Tremblay L, Feliciano DV, et al. A prospective study for the detection of vascular injury in adult and pediatric patients with cervicothoracic seat belt signs. J Trauma. 2002;52:618–623; discussion 623–624
- ↑ Sherbaf FG, Chen B, Pomeranz T, et al. Value of emergent neurovascular imaging for “Seat belt injury”: A multi-institutional study. American Journal of Neuroradiology. 2021;42(4):743-748
- ↑ Desai NK, et al. Screening CT angiography for pediatric blunt cerebrovascular injury with emphasis on the cervical “seat- belt sign.” AJNR Am J Neuroradiol. 2014 Sep;35(9):1836-40. PMID: 24722311.