1. C-spine precautions Oct/21/2008

2. 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 ?

3. Air way with C-spine precautions Breathing Circulation Disability Exposure with environmental control Secondary survey

9. Missed injuries 10% in head trauma patients 6% in patients without head injury Risk of disease transmission

10. 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

11. 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

12. 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

13. Noncontiguous traumatic spinal injuries in 5-20%

14. Lateral C-Spine

15. 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