{"id":5407,"date":"2011-07-14T20:26:16","date_gmt":"2011-07-14T20:26:16","guid":{"rendered":"http:\/\/crashtext.org\/misc\/spinal-injuries.htm\/"},"modified":"2014-02-07T11:16:23","modified_gmt":"2014-02-07T16:16:23","slug":"spinal-injuries","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/trauma\/system\/spinal-injuries.htm\/","title":{"rendered":"Spinal Trauma"},"content":{"rendered":"

<\/span>Spinal Immobilization<\/span><\/h2>\n
from trauma professional\u2019s blog:
\nBottom line: Get your patients off that backboard ASAP! I recommend sliding it out when they are logrolled to examine the back. The board is of little or no benefit to spine stability in a cooperative patient. And we have ways of encouraging cooperation if they are not.<\/address>\n

Reference: How Much Time Does it Take to Get a Pressure Ulcer? Integrated Evidence from Human, Animal, and In Vitro Studies. Ostomy Wound Management. 54(10):26-8, 30-5, 2008.<\/p>\n

<\/span>Spinal Injuries<\/span><\/h2>\n

Dermatome Map and Reflexes from M Lin<\/a><\/p>\n

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Cervical Spine<\/h5>\n

<\/span>Clinical Decision Rules<\/span><\/h2>\n

<\/span>Canadian C-Spine Rules (NEJM 2003;349:2510-8 and Annals EM 2003;42(3):395)<\/span><\/h3>\n

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For patients with trauma who are alert (as indicated by a score of 15 on the Glasgow Coma Scale) and in stable condition and in whom cervical-spine injury is a concern, the determination of risk factors guides the use of cervical-spine radiography. A dangerous mechanism is considered to be a fall from an elevation 3 ft or 5 stairs; an axial load to the head (e.g., diving); a motor vehicle collision at high speed (>100 km\/hr) or with rollover or ejection; a collision involving a motorized recreational vehicle; or a bicycle collision. A simple rear-end motor vehicle collision excludes being pushed into oncoming traffic, being hit by a bus or a large truck, a rollover, and being hit by a high-speed vehicle. \u00a099.4% Sensitive and 45.1% Specific<\/p>\n

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\u00a0<\/a><\/p>\n

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How important is the age 65 criterion in the Canadian C-Spine Rule? (Stiell IG)<\/strong> For the older patients it the sensitivity of CCR was 92.1% (78-97%) and would have missed 3 injuries. CONCLUSIONS: In older patients, several CCR criteria, particularly “Dangerous Mechanism”, perform less well and the overall sensitivity of the CCR is insufficient. The “Age 65” criterion remains an important component of the CCR and all potential neck injury patients aged 65 and older should undergo imaging.<\/p>\n

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Ann Emerg Med.<\/a> 2004 Apr;43(4):507-14. Retrospective application of the NEXUS low-risk criteria for cervical spine radiography in Canadian emergency departments.<\/p>\n

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N Engl J Med.<\/a> 2003 Dec 25;349(26):2510-8.\u00a0 The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. <\/a><\/p>\n

<\/span>Nexus C-Spine Rules<\/span><\/h3>\n

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(Ann Emerg Med 1992)<\/p>\n

Actual Nexus Study<\/a><\/p>\n

    \n
  1. No midline tenderness<\/li>\n
  2. No pain with neck movement<\/li>\n
  3. No distracting injury<\/li>\n
  4. No Neurodeficit<\/li>\n
  5. No Alcohol or Drugs<\/li>\n
  6. No Altered Mental Status<\/li>\n<\/ol>\n