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C-spine precautions
Oct/21/2008
• 18 year old girl involved in MVC, front seat passenger, no seat-belt. The car hit the traffic light at 100km/hr , gas tank exploded and fire started, extraction time was 45 minutes, no Hx. Of LOC
• What is your next step ?
• Air way with C-spine precautions
• Breathing
• Circulation
• Disability
• Exposure with environmental control
• Secondary survey
Missed injuries
• 10% in head trauma patients
• 6% in patients without head injury
• Risk of disease transmission
C-spine in a trauma patient
• Suspect injury in all patients– Pain and tenderness, decreased LOC,
injuries above the clavicle, weak Ext. or altered sensation
• Careful neurological exam– Complete– Incomplete– ASIA score
• What to do if you suspect injury:– Hard collar and back board– Transfer with in-line manual cervical
immoblization– Keeping shoulders and hips aligned at all
times
• Neurogenic shock• Sequelae of secondary cascade of cellular
dysfunction– Inflammation, edema, hemorrhage,free
radicals,lipid peroxidation, electrolytes imbalance
• Methylprednisone– 30mg/kg bolus, 5.4mg/kg/h infusion
• Noncontiguous traumatic spinal injuries in 5-20%
Lateral C-Spine
C-Spine Landmark• 1. Anterior arch of the atlas
• 2. Dens of axis
• 3. Posterior arch of the atlas
• 4. Soft palate
• 5. Root of the tongue
• 6. Transverse process
• 7. Intervertebral disc
• 8. Inferior articular process
• 9. Superior articular process
• 10. Zygapophyseal (facet) joint
• 11. Spinous process of C7
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