C-Spine Trauma

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Step 1: Protect the Spine

• Apply cervical collar

Step 2: Apply NEXUS Criteria

• Use the “SPINE” mnemonic
  • Spinal midline tenderness
  • Painful distracting injury
  • Intoxication
  • Neurologic deficit
  • Encephalopathy

Step 3: If Patient Has None of the NEXUS Criteria… You Are Done!

Step 4: If Patient Has Positive NEXUS Criteria…

• Obtain CT scan of the cervical scan without contrast

Step 5: Clear the C-Spine

• If CT scan negative -> Have patient turn head 45 degrees to right and left
  • If patient has no limitation and no paresthesias or neurologic deficit…
    • Remove collar
  • If still concerned for spinal injury despite normal CT
    • Keep collar on and have patient follow up in clinic for reexam

Unstable Cervical Spine Fractures

• Mnemonic: Jefferson Bit Off a Hangmans Tit
  • Jefferson fracture
  • Bilateral facet dislocation
  • Odontoid fracture
  • Atlantooccipital dislocation
  • Hangman’s fracture
  • Teardrop fracture

Additional Reading

• NEXUS Criterial for C-Spine Imaging (MDCalc)
• Unstable Spine Fractures (WikEM)