Emergency - C-spine injury

From CambridgeNotes

ABC

  • Protect C-spine with collar, sandbags and tape

History and Examination

  • Is there neck pain?
  • What is last normal level? Is there sparing?
    • Dermatomes: Upper limb screen - assess sensation in continuous motion from lateral arm to hand to medial arm; Lower limb screen - assess sensation from lateral hip to medial knee to lateral foot
    • Myotomes: Upper limb screen - position patient with shoulder adducted, elbows flexed to 90º, fingers gripping examiner then ask patient to resist while you try and move their limbs; Lower limb screen - ask patient to push feet in and out, ask them to point their feet up and down
    • Sacrum: perianal sensation and voluntary contraction of anal sphincter

Investigations

  • Paraplegia or quadriplegia assumed to have C-spine injury → do not need films
  • Awake, alert, sober, neurologically normal and have no neck pain (and no distracting injury!) unlikely to have injury → while supine remove collar and palpate C-spine
    • If not tender ask patient to move neck side-to-side then flex/extend
    • If still not tender assume no injury
  • Awake and alert but does have neck pain then C-spine injury must be excluded → C-spine series (lateral, AP, and open-mouth)
    • If normal collar removed, patient asked to flex neck and lateral flexion X-ray taken
    • If no apparent subluxation C-spine cleared otherwise CT
  • Comatose, altered consciousness, or young (no history) → C-spine series
    • If normal clear after consulting specialist

Definitive Treatment

  • Consider prednisolone within first 8 hours
  • Subsequent management by surgeons

References

  1. ATLS
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