Difference between revisions of "Blunt neck trauma"

(Text replacement - "==Diagnosis==" to "==Evaluation==")
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==Background==
 
==Background==
 
*Suspect vascular damage to cord if discrepancy between neuro deficit and level of spinal column injury
 
*Suspect vascular damage to cord if discrepancy between neuro deficit and level of spinal column injury
*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]]
 
[[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'')
 +
''T''racheal deviation''
 +
''W''ounds
 +
''E''ternal 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==
 
==Differential Diagnosis==
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==Evaluation==
 
==Evaluation==
 +
 
===Fracture===
 
===Fracture===
 
{{C-spine NEXUS}}
 
{{C-spine NEXUS}}
 
 
^If find injury consider CT C-spine, x-ray rest of spine
 
^If find injury consider CT C-spine, x-ray rest of spine
  
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{{Denver Screening Criteria}}
 
{{Denver Screening Criteria}}
  
 +
==
 
===Pediatrics===
 
===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>
 
*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>
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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 specific diagnosis
 
**See specific diagnosis
  

Revision as of 16:59, 5 September 2016

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
Three column concept of spinal fracture stability

Clinical Features

  • Signs of life-threatening neck or upper thoracic injury (look for TWELVE)

Tracheal deviation Wounds Eternal markings Laryngeal disruption Venous distention Emphysema (surgical)

Differential Diagnosis

Neck Trauma

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
    • Isolated seatbelt sign without other neurologic symptoms has not been identified as a risk factor[3][4]

==

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. [5]

Management

Disposition

  • Based on specific diagnosis

See Also

References

  1. 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.
  2. Mahadevan, et al. Interrater reliability of cervical spine injury criteria inpatients with blunt trauma. Ann Emerg Med1998;31:197-201
  3. 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
  4. 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
  5. 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.