Difference between revisions of "Blunt neck trauma"

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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
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*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
 
*[[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]]
 
  
 
==Clinical Features==
 
==Clinical Features==
*Signs of life-threatening neck or upper thoracic injury (look for ''TWELVE'')
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*Signs of life-threatening neck or upper thoracic injury (look for ''TWELVE''):
''T''racheal deviation'',
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:'''T'''racheal deviation'',
''W''ounds,
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:'''W'''ounds,
''E''xternal markings,
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:'''E'''xternal markings,
''L''aryngeal disruption,
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:'''L'''aryngeal disruption,
''V''enous distention,
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:'''V'''enous distention,
''E''mphysema (surgical)
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:'''E'''mphysema (surgical)
 
*Features may include signs and symptoms of:
 
*Features may include signs and symptoms of:
 
**[[Spinal cord injury]]
 
**[[Spinal cord injury]]
 
**[[Vertebral and Carotid Artery Dissection]]
 
**[[Vertebral and Carotid Artery Dissection]]
 
**Laryngeal or [[tracheal injury]]
 
**Laryngeal or [[tracheal injury]]
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 +
===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>
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
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==Evaluation==
 
==Evaluation==
 +
===Workup===
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*Consider x-ray or non-contrast cervical CT to evaluate for bone/cord injury (see below)
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**May later consider cervical MRI to further evaluate for cord injury
 +
*Consider CTA neck with contrast to evaluate for vascular injury (see below)
  
===Fracture===
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===General Approach===
{{C-spine NEXUS}}
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*If concern for cervical spine injury, use a [[cervical spine clearance]] decision rule to determine need for imaging
:^If find injury consider CT C-spine, x-ray rest of spine
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*Perform a neuro exam, to determine concern for [[spinal cord injury]]
 
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*If concern for vascular injury, use the [[Denver screening criteria]]
===[[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==
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*Hospital
 
*Hospital
 
**Secure ABCs
 
**Secure ABCs
 +
**See [[cervical spine clearance]]
 
**See specific diagnosis
 
**See specific diagnosis
  
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*[[Canadian cervical spine rule]]
 
*[[Canadian cervical spine rule]]
 
*[[NEXUS cervical spine rule]]
 
*[[NEXUS cervical spine rule]]
 +
*[[Strangulation]]
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*[[Vertebral and carotid artery dissection]]
  
 
==External Links==
 
==External Links==
[https://coreem.net/podcast/episode-173-0-blunt-neck-trauma/ Blunt Neck Trauma from CoreEM]
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*[https://coreem.net/podcast/episode-173-0-blunt-neck-trauma/ Blunt Neck Trauma from CoreEM]
  
 
==References==
 
==References==

Latest revision as of 12:51, 22 February 2020

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)

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. [1]

Differential Diagnosis

Neck Trauma

Other

Evaluation

Workup

  • Consider x-ray or non-contrast cervical CT to evaluate for bone/cord injury (see below)
    • May later consider cervical MRI to further evaluate for cord injury
  • Consider CTA neck with contrast to evaluate for vascular injury (see below)

General Approach

Management

Disposition

  • Based on specific diagnosis

See Also

External Links

References

  1. 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.