Scenario 13.3 Pulseless Lower Extremity Fracture/ Cervical Spine Fracture 1

Chest X-ray 2

CT Head Preliminary Report Normal No evidence of fracture or bleed 3

Cervical Spine Images 4

CT Cervical Spine Radiology Report Indication: Status post fall Cervical spine CT: Study is acquired at 2-mm intervals from the skull base through T3. Examination demonstrates hyperflexion teardrop fractures at C4 and C5 with bilateral laminar fractures at both levels. There is retropulsion predominantly at the C5 level narrowing the spinal canal to 10.3 mm. There is a high likelihood of associated cord injury. Marked prevertebral soft tissue swelling is present. Impression: Two contiguous level hyperflexion teardrop fractures with associated bilateral laminar fracture. 5

Thoracic and Lumbar X-rays No evidence of fracture, subluxation 6

AP Pelvis Xray 7

Left Lower Extremity X-ray 8

FAST Examination 9

Complete Blood Count WBC /mm 3 HGB g/dL HCT % PLT /mm 3 10

Basic Metabolic Panel Glucose mg/dL BUN mg/dL Sodium meq/L Potassium meq/L Chloride meq/L CO meq/L Creatinine mg/dL 11

Coagulation Panel PT s INR PTT s 12

Clarityclear Colorrust Glucosenegativenegative mg/dL Bilirubinnegative Ketones80 mg/dLnegative mg/dL Sp. grav Bloodlarge amountnegative pH Protein30negative mg/dL Urobilinogen EU/dL Nitritesnegative Leukocytesnegative 13 Urinalysis

Urine microscopy Urine RBCsoccasionalNS/HPF Urine WBCs1-5/HPFNS/HPF Urine epithelia1-5/HPFNS/HPF Urine bacteriasmall amount/HPF Urine castsnone seenNS/LPF 14

Pregnancy Test Urine HCGnegative 15

CPK IU/L 16

Arterial Blood Gas Arterial blood pH Arterial PO mmHg Arterial CO mmHg Arterial HCO mmol/L Base E/D mmol/L Arterial % sat.98%96-100% Ventilation 17