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 | |||
*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''): | |||
:'''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]] | |||
== | ===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== | ||
{{Blunt neck trauma DDX}} | |||
=== | ===Other=== | ||
* | *[[Head trauma]] | ||
* | *[[Thoracic trauma]] | ||
== | ==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=== | ||
[[ | *If concern for cervical spine injury, use a [[cervical spine clearance]] decision rule to determine need for imaging | ||
* | *Perform a neuro exam, to determine concern for [[spinal cord injury]] | ||
*If concern for vascular injury, use the [[Denver screening criteria]] | |||
* | |||
== | ==Management== | ||
*Prehospital | |||
* | **See the [[EBQ:Prehospital Spine Immobilization|NAEMSP National Guidelines for Spinal Immobilization]] | ||
*Hospital | |||
**Secure ABCs | |||
**See [[cervical spine clearance]] | |||
**See specific diagnosis | |||
=== | ==Disposition== | ||
*Based on specific diagnosis | |||
* | |||
== | ==See Also== | ||
* | *[[Penetrating neck trauma]] | ||
* | *[[Cervical spine clearance]] | ||
** | *[[Canadian cervical spine rule]] | ||
* | *[[NEXUS cervical spine rule]] | ||
* | *[[Strangulation]] | ||
*[[Vertebral and carotid artery dissection]] | |||
== | ==External Links== | ||
* | *[https://coreem.net/podcast/episode-173-0-blunt-neck-trauma/ Blunt Neck Trauma from CoreEM] | ||
== | ==References== | ||
<references/> | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
[[Category: | [[Category:Orthopedics]] |
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)
- Features may include signs and symptoms of:
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
- Penetrating neck trauma
- Blunt neck trauma
- Cervical injury
- Neurogenic shock
- Spinal cord injury
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
- If concern for cervical spine injury, use a cervical spine clearance decision rule to determine need for imaging
- Perform a neuro exam, to determine concern for spinal cord injury
- If concern for vascular injury, use the Denver screening criteria
Management
- Prehospital
- Hospital
- Secure ABCs
- See cervical spine clearance
- See specific diagnosis
Disposition
- Based on specific diagnosis
See Also
- Penetrating neck trauma
- Cervical spine clearance
- Canadian cervical spine rule
- NEXUS cervical spine rule
- Strangulation
- Vertebral and carotid artery dissection
External Links
References
- ↑ 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.