Aashi
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A 45-year-old man is struck by a motor vehicle and is transported by a med flight to the local emergency department. He is reported to be intoxicated with a Glasgow score of 12/15 on the scene of the accident. He was struck by a vehicle while crossing the street. On arrival, the patient is awake and somewhat combative. He is alert to person only. His temperature is 37.0 C (98.6 F), blood pressure is 150/80 mm Hg, pulse is 112/min, and respirations are 20/min. Primary survey reveals a well-developed man in mild distress. He is in a cervical collar. He has obvious lower extremity tibia fractures bilaterally and a laceration on his forehead. The most appropriate manner to clear the patient's cervical spine from injury is
A. cervical spine plain radiographs
B. CT scan of the neck
C. flexion, extension, and lateral rotation of the neck while assessing any pain response from the patient
D. manual palpation of the patient's neck for any obvious injury
E. this patient cannot have his cervical spine cleared at this time
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| robin082006
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B. CT scan of the neck
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| vanshita
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A cervical spine plain radiographs
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| amkhit
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plain radiographs of the spine should suffice for screening . CT Scans / MRI for confirming , localising injury or in case of high suspicion or neurological deficit
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| Aashi
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The correct answer is E.
This patient is at high risk for a cervical spine injury and a key component of any trauma evaluation is ensuring that none exists in situations such as these. The two components of a successful evaluation for clearance are an imaging test of some sort and a lucid, mentally clear patient. Once imaging is completed, the patient is asked, during the examination part, to express pain or discomfort if there is any. This patient is intoxicated and therefore is not able to reliably indicate pain during the examination. Once he is sober the exam can be undertaken once his imaging study is read as normal.
Cervical spine plain radiographs (choice A) or CT scan of the neck (choice B) are both appropriate selections for imaging. Depending on the expertise of the radiologist, the sensitivity of either for detecting cervical spine injury is equivalent. No imaging mode however can be utilized in the absence of a physical examination.
Flexion, extension, and lateral rotation of the neck while assessing any pain response from the patient (choice C) would be the appropriate sequence of events after a cleared image for any obvious injury if he were not intoxicated.
Manual palpation of the patient's neck for any obvious injury (choice D) is not an adequate physical examination. Exam must include lateral rotation and flexion-extension of the patient's neck as well.
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"Obstacles are those frightful things you see when you take your EYES off your goal."
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| usmle12
Forum Senior
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WOW ashi are u tellinng that u are going to amnipulate a patients spine with potentiel
injury and convert it to full blown paralysis...i cant believe it
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| NE
Forum Guru
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usmle12 I guess you read answers C and E in the same time!
Neurologic exam doesn't mean you are going to manipulate the cervical spine- just to asses sensitivity+ motor function .
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