darkhorse
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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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| cool doctor
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D?
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| tamerbashir
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B?
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| Kamsi
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A
MRI is the best for d spine and better than CT scan.Abd X-ray is also useful
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| titly
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B. 
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| cool doctor
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I answered the next step
But the best I think is B
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| darkhorse
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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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| tamerbashir
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| mildanemia
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@ Darkhorse,
Is that the answer to the question or is that your explanation ?
Imaging studies should be ordered for a patient with a neurological deficit or pain on palpation. I believe that this patient exhibits a neurological deficit so he would be subject to imaging studies. Kaplan doesn't mention anything about the 2 components to conclude cervical spine injury. If the patient was unconscious wouldn't you have to establish the answer to that question on your own ?
I think the appropriate answer is B because this patient is probably going to get a Head CT, the CT should be extended to the neck. X-rays would have to be AP, Lateral and Odontoid views; I'm not sure if that is what they mean by A.
Any input ?
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| funkdoc19
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the question states: The most appropriate manner to clear the patient’s cervical spine from injury is
then x rays are all you need, ct is only indicated if x ray is equivical
however since this patient has
a) intoxication
b) distracting injuries
i'd leave the collar on and answer E
at least thats how we do it in our trauma bay in chicago
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| Miradautas Vras
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I get exasperated at this difference of opinion between kaplan and UW. Asking anally minute "next step" questions is sadistic douchebaggery IMHO. Even UW varies a lot between it's own explanations. In this case I'd certainly go for neck x-ray if not for that forehead laceration. Priority should be suturing that first and then taking a spine x-ray
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| WaqasQureshi
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the answer is E
for concious and for unconcious patients, the protocols of cervical injury management are different
For concious, you have to palpate first and if there is tenderness, go for CERVICAL SPINE 3 view imaging. IN case its is clear, you can go for flexion and extension x rays in supervised assistance. If they are clear then go for FULL RANGE OF MOTION.
For unconcious person, keep cervical collar. Assess by using CT scan but that doesnt rule out the ligamentious injury until the patient himself doesnt undergo flexion and extension without any pain.
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