C spine clearance. Clinical clearance 2 rules to remember: Nexus and canadian c-spine rule NEXUS:...
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Transcript of C spine clearance. Clinical clearance 2 rules to remember: Nexus and canadian c-spine rule NEXUS:...
![Page 1: C spine clearance. Clinical clearance 2 rules to remember: Nexus and canadian c-spine rule NEXUS: –Focal neurological deficit –Midline spinal tenderness.](https://reader033.fdocuments.us/reader033/viewer/2022051123/5a4d1b2d7f8b9ab05999996c/html5/thumbnails/1.jpg)
C spine clearance
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Clinical clearance
• 2 rules to remember: Nexus and canadian c-spine rule
• NEXUS:– Focal neurological deficit– Midline spinal tenderness– ALOC– Intoxication– Distracting injury
![Page 3: C spine clearance. Clinical clearance 2 rules to remember: Nexus and canadian c-spine rule NEXUS: –Focal neurological deficit –Midline spinal tenderness.](https://reader033.fdocuments.us/reader033/viewer/2022051123/5a4d1b2d7f8b9ab05999996c/html5/thumbnails/3.jpg)
What is a distracting injury?
• Original study: Not explicitly stated• Other suggestions: Long bone fracture,
intra-abdominal injury, degloving injury, large laceration, intracranial injury.
• Chest injury may be more distracting• Injuries may not be distracting at all• Are they distracted by pain or ALOC
because of analgesia?
![Page 5: C spine clearance. Clinical clearance 2 rules to remember: Nexus and canadian c-spine rule NEXUS: –Focal neurological deficit –Midline spinal tenderness.](https://reader033.fdocuments.us/reader033/viewer/2022051123/5a4d1b2d7f8b9ab05999996c/html5/thumbnails/5.jpg)
Ages
• Caution over 65• Use NEXUS for children• Caution under 8
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Imaging
• Sensitivity of plain films is ~85%• Sensitivity of CT >95%• Plain films no good if you have big
shoulders
![Page 7: C spine clearance. Clinical clearance 2 rules to remember: Nexus and canadian c-spine rule NEXUS: –Focal neurological deficit –Midline spinal tenderness.](https://reader033.fdocuments.us/reader033/viewer/2022051123/5a4d1b2d7f8b9ab05999996c/html5/thumbnails/7.jpg)
What I do
• Age >65: CT• Age 45-65: Probably CT unless very low
risk, in which case why image them• Age <45 Start with plain films unless high
suspicion of injury• Young, football player, low suspicion of
injury: Go to xray, pull on patient’s arms
![Page 8: C spine clearance. Clinical clearance 2 rules to remember: Nexus and canadian c-spine rule NEXUS: –Focal neurological deficit –Midline spinal tenderness.](https://reader033.fdocuments.us/reader033/viewer/2022051123/5a4d1b2d7f8b9ab05999996c/html5/thumbnails/8.jpg)
How to interpret a C-spine film
• Plain films only! wait on the report for a CT• Check film adequacy
– All vertebrae covered from skull to T1
![Page 9: C spine clearance. Clinical clearance 2 rules to remember: Nexus and canadian c-spine rule NEXUS: –Focal neurological deficit –Midline spinal tenderness.](https://reader033.fdocuments.us/reader033/viewer/2022051123/5a4d1b2d7f8b9ab05999996c/html5/thumbnails/9.jpg)
•Alignment: Anterior line, posterior line and spinolaminar line•Bones: look through all vertebrae for breaks in cortex
Lateral view
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•Disc spaces – should be approximately equal in height•Soft tissues: 7mm wide at C2, 2cm wide at C7•Or <1/3 vertebral body above C4 and <100% below C4
![Page 11: C spine clearance. Clinical clearance 2 rules to remember: Nexus and canadian c-spine rule NEXUS: –Focal neurological deficit –Midline spinal tenderness.](https://reader033.fdocuments.us/reader033/viewer/2022051123/5a4d1b2d7f8b9ab05999996c/html5/thumbnails/11.jpg)
Check alignment – Lateral edges and spinous processesSpacing – spinous processes should be line up and spaced evenly
AP view
![Page 12: C spine clearance. Clinical clearance 2 rules to remember: Nexus and canadian c-spine rule NEXUS: –Focal neurological deficit –Midline spinal tenderness.](https://reader033.fdocuments.us/reader033/viewer/2022051123/5a4d1b2d7f8b9ab05999996c/html5/thumbnails/12.jpg)
Adequate if shows the alignment of lateral masses on both sidesDistance between the peg and lateral masses should be equal
Peg View
![Page 13: C spine clearance. Clinical clearance 2 rules to remember: Nexus and canadian c-spine rule NEXUS: –Focal neurological deficit –Midline spinal tenderness.](https://reader033.fdocuments.us/reader033/viewer/2022051123/5a4d1b2d7f8b9ab05999996c/html5/thumbnails/13.jpg)
Swimmers view
• Get a CT.