Submitted by: Thomas Morgan MS4

Faculty reviewer: Sandra Oldham M.D.

Date accepted: 30, August 2007

Radiological Category: Principal Modality (1):

Principal Modality (2):

Primary Radiographic Survey in a Trauma Patient

Emergency

CT

Plain films

Case History

• 25 year old male victim of a high speed, head-on MVC w/prolonged extrication

• Restrained driver

• + Loss of consciousness

• Intubated en route, transferred to MHH via Life-Flight

• Assessment by Trauma team revealed:• Tachycardic, normotensive• R hemotympanum, L ear laceration, abnormal but stable pelvis, no

obvious deformity, Glasgow Coma Score (GCS) 3

Radiological Presentations CXR: 2am

Radiological PresentationsCRX: 7am

AP Pelvis

Radiological Presentations

Radiological Presentations

Radiological Presentations

Clinical:

The NEXUS criteria state that a patient with suspected c-spine injury can be cleared providing the following:

No posterior midline cervical spine tenderness is present. No evidence of intoxication is present. The patient has a normal level of alertness. No focal neurologic deficit is present. The patient does not have a painful distracting injury.

90.7% sensitive for clearing low risk patients without the need for radiographic studies.

Clearing a Cervical Spine Injury

Radiological (plain films):

Lateral View:-anterior contour line -posterior contour line -spinolaminar contour line

Each of these lines should form a smooth lordotic curve. An exception occurs in young children who may have a benign pseudosubluxation in the upper cervical spine. Check individual vertebrae thoroughly for obvious fracture or changes in bone density.ADI- space between dens and atlas <3mm in adults, 4-5mm in kidsSoft tissue swelling anterior to vertebral bodies

Odontoid View: Important for visualizing the dens (C2) and looking at the symmetry between the dens and the lateral masses of C1. Can also see if the spinous processes are midline

Clearing a Cervical Spine Injury

Coronal and Sagittal Views

CT Neck

Radiological Presentations

Radiological Presentations

Radiological Presentations

Radiological Presentations

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Radiological Presentations

•Admitted to STICU

– L chest tube and ventilator support

– Neurosurgery followed traumatic brain injury with bolt ICP monitor, but did not operate

– Orthopedics followed but did not operate

– Course complicated by pneumonia and SIADH

– Neurological status improved minimally

– Transferred to Long term care facility

Hospital Course

1. Cervical Spine Injuries. May 11th 2006. Jorma B. Mueller. Emedicine.com

2. American Academy of Family Physicians. Cervical Fractures Vol. 52/No. 2 (Jan. 15 1999). Mark. A. Graber MD, Mary Kathol MD

3. Special Thanks to: Dr. Sitton, John Larkin MS4

References