C-spine precautions

Oct/21/2008

• 18 year old girl involved in MVC, front seat passenger, no seat-belt. The car hit the traffic light at 100km/hr , gas tank exploded and fire started, extraction time was 45 minutes, no Hx. Of LOC

• What is your next step ?

• Air way with C-spine precautions

• Breathing

• Circulation

• Disability

• Exposure with environmental control

• Secondary survey

Missed injuries

• 10% in head trauma patients

• 6% in patients without head injury

• Risk of disease transmission

C-spine in a trauma patient

• Suspect injury in all patients– Pain and tenderness, decreased LOC,

injuries above the clavicle, weak Ext. or altered sensation

• Careful neurological exam– Complete– Incomplete– ASIA score

• What to do if you suspect injury:– Hard collar and back board– Transfer with in-line manual cervical

immoblization– Keeping shoulders and hips aligned at all

times

• Neurogenic shock• Sequelae of secondary cascade of cellular

dysfunction– Inflammation, edema, hemorrhage,free

radicals,lipid peroxidation, electrolytes imbalance

• Methylprednisone– 30mg/kg bolus, 5.4mg/kg/h infusion

• Noncontiguous traumatic spinal injuries in 5-20%

Lateral C-Spine

C-Spine Landmark• 1. Anterior arch of the atlas

• 2. Dens of axis

• 3. Posterior arch of the atlas

• 4. Soft palate

• 5. Root of the tongue

• 6. Transverse process

• 7. Intervertebral disc

• 8. Inferior articular process

• 9. Superior articular process

• 10. Zygapophyseal (facet) joint

• 11. Spinous process of C7