Difference between revisions of "Blunt neck trauma"

(Vertebral and Carotid Artery Dissection)
(Evaluation)
 
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==Background==
 
==Background==
[[File:Three-column-concept-2.jpg|thumb|Three column concept of spinal fracture stability]]
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*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
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*[[Spinal cord injury]] is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted
*Cord injury is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted
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==Clinical Features==
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*Signs of life-threatening neck or upper thoracic injury (look for ''TWELVE''):
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:'''T'''racheal deviation'',
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:'''W'''ounds,
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:'''E'''xternal markings,
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:'''L'''aryngeal disruption,
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:'''V'''enous distention,
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:'''E'''mphysema (surgical)
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*Features may include signs and symptoms of:
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**[[Spinal cord injury]]
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**[[Vertebral and Carotid Artery Dissection]]
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**Laryngeal or [[tracheal injury]]
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===Pediatrics===
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*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==
 
{{Blunt neck trauma DDX}}
 
{{Blunt neck trauma DDX}}
  
==Workup==
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===Other===
===Fracture===
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*[[Head trauma]]
{{C-spine NEXUS}}
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*[[Thoracic trauma]]
 
 
^If find injury consider CT C-spine, x-ray rest of spine
 
  
===[[Spinal cord trauma]]===
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==Evaluation==
*Neuro exam
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===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
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*Consider CTA neck with contrast to evaluate for vascular injury (see below)
  
===[[Vertebral and Carotid Artery Dissection]]===
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===General Approach===
 
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*If concern for cervical spine injury, use a [[cervical spine clearance]] decision rule to determine need for imaging
{{Denver Screening Criteria}}
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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]]
'''Pediatrics'''
 
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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**See the [[EBQ:Prehospital Spine Immobilization|NAEMSP National Guidelines for Spinal Immobilization]]
 
**See the [[EBQ:Prehospital Spine Immobilization|NAEMSP National Guidelines for Spinal Immobilization]]
 
*Hospital
 
*Hospital
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**Secure ABCs
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**See [[cervical spine clearance]]
 
**See specific diagnosis
 
**See specific diagnosis
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==Disposition==
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*Based on specific diagnosis
  
 
==See Also==
 
==See Also==
 
*[[Penetrating neck trauma]]
 
*[[Penetrating neck trauma]]
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*[[Cervical spine clearance]]
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*[[Canadian cervical spine rule]]
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*[[NEXUS cervical spine rule]]
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*[[Strangulation]]
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*[[Vertebral and carotid artery dissection]]
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==External Links==
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*[https://coreem.net/podcast/episode-173-0-blunt-neck-trauma/ Blunt Neck Trauma from CoreEM]
  
==Source==
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==References==
*National Spinal Cord Injury Statistical Center (NSCISC). Spinal Cord Injury. Facts and Figures at a Glance. Birmingham, Ala: NSCISC; July 1996
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<references/>
*Ivy ME, Cohn SM. Addressing the myths of cervical spine injury management. Am J Emerg Med. Oct 1997;15(6):591-5
 
*Woodring JH, Lee C, Duncan V. Transverse process fractures of the cervical vertebrae: are they insignificant? J Trauma. June 1993; 34(6):797-802.
 
*Tintinalli's
 
  
 
[[Category:Trauma]]
 
[[Category:Trauma]]
[[Category:Ortho]]
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[[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)

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.