Blunt neck trauma: Difference between revisions

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==Background==
==Background==
[[File:Three-column-concept-2.jpg|thumb|Three column concept of spinal fracture stability]]
*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
*Cord injury is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted


==Clinical Features==
==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==
==Differential Diagnosis==
{{Blunt neck trauma DDX}}
{{Blunt neck trauma DDX}}


==Diagnosis==
===Other===
===Fracture===
*[[Head trauma]]
{{C-spine NEXUS}}
*[[Thoracic trauma]]
 
^If find injury consider CT C-spine, x-ray rest of spine
 
===[[Spinal cord trauma]]===
*Neuro exam


===[[Vertebral and Carotid Artery Dissection]]===
==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)


{{Denver Screening Criteria}}
===General Approach===
 
*If concern for cervical spine injury, use a [[cervical spine clearance]] decision rule to determine need for imaging
===Pediatrics===
*Perform a neuro exam, to determine concern for [[spinal cord injury]]
*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>
*If concern for vascular injury, use the [[Denver screening criteria]]


==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
**Secure ABCs
**See [[cervical spine clearance]]
**See specific diagnosis
**See specific diagnosis
==Disposition==
*Based on specific diagnosis


==See Also==
==See Also==
*[[Penetrating neck trauma]]
*[[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==
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[[Category:Trauma]]
[[Category:Trauma]]
[[Category:Ortho]]
[[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.