We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
from Section 5 - Orthopaedic surgery
Published online by Cambridge University Press: 05 July 2015
Rules
• All trauma patients have a C-spine injury until proven otherwise.
• Patient's neck can be cleared by radiographic or clinical means.
Clinical clearance requires:
1. No high-risk factors regarding the injury, such as:
a. diving or axial injury
b. fall from height >3 feet (90 cm)/five steps
c. high-speed car collision >60 mph (97 km/h)
d. bike or recreational vehicle collision
2. No high-risk factors regarding the patient:
a. age >65 or <16
b. intoxicated or altered mental status
c. GCS <15
d. abnormal neurology
e. no distracting injuries
f. midline cervical tenderness
Clinical clearance system
1. Completion of ATLS primary survey.
2. History regarding the event and evaluation of the patient for risk factors.
3. Assessment for the presence of distracting injuries (presence of distracting injuries requires cervical imaging).
4. Full neurological examination.
5. In-line immobilisation of C-spine and removal of collar.
6. Second assessor palpates cervical spine. If there is no pain the patient is then asked to actively rotate the head left and right.
7. If there is still no neck pain or numbness/tingling in the limbs the cervical spine can be cleared without radiographic evaluation.
Radiographic clearance system
• Cervical spine radiographs (See Chapter 49, Cervical spine x-ray):
• AP and lateral views.
• All C1–7 and superior aspect of T1 vertebrae must be visualised.
• Swimmer's view or traction on arms (if traumatic injury permits) are needed if standard views are inadequate.
• Current recommendations are for computed tomography (CT) imaging.
To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Find out more about the Kindle Personal Document Service.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.
To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.
