1. Submitted by:Thomas Morgan MS4 Faculty reviewer:Sandra Oldham M.D. Date accepted:30, August 2007 Radiological Category:Principal Modality (1): Principal Modality (2): Primary Radiographic Survey in a Trauma Patient Emergency CT Plain films

2. Case History 25 year old male victim of a high speed, head-on MVC w/prolonged extrication Restrained driver + Loss of consciousness Intubated en route, transferred to MHH via Life-Flight Assessment by Trauma team revealed: Tachycardic, normotensive R hemotympanum, L ear laceration, abnormal but stable pelvis, no obvious deformity, Glasgow Coma Score (GCS) 3

3. Radiological Presentations CXR: 2am

4. Radiological Presentations CRX: 7am

5. AP Pelvis

7. Radiological Presentations

10. Clinical: The NEXUS criteria state that a patient with suspected c-spine injury can be cleared providing the following: No posterior midline cervical spine tenderness is present. No evidence of intoxication is present. The patient has a normal level of alertness. No focal neurologic deficit is present. The patient does not have a painful distracting injury. 90.7% sensitive for clearing low risk patients without the need for radiographic studies. Clearing a Cervical Spine Injury

11. Radiological (plain films): Lateral View: -anterior contour line -posterior contour line -spinolaminar contour line Each of these lines should form a smooth lordotic curve. An exception occurs in young children who may have a benign pseudosubluxation in the upper cervical spine. Check individual vertebrae thoroughly for obvious fracture or changes in bone density. ADI- space between dens and atlas <3mm in adults, 4-5mm in kids Soft tissue swelling anterior to vertebral bodies Odontoid View: Important for visualizing the dens (C2) and looking at the symmetry between the dens and the lateral masses of C1. Can also see if the spinous processes are midline Clearing a Cervical Spine Injury

12. Coronal and Sagittal Views

13. CT Neck

14. Radiological Presentations

18. \

19. Admitted to STICU – L chest tube and ventilator support –Neurosurgery followed traumatic brain injury with bolt ICP monitor, but did not operate –Orthopedics followed but did not operate –Course complicated by pneumonia and SIADH –Neurological status improved minimally –Transferred to Long term care facility Hospital Course

20. 1. Cervical Spine Injuries. May 11th 2006. Jorma B. Mueller. Emedicine.com 2. American Academy of Family Physicians. Cervical Fractures Vol. 52/No. 2 (Jan. 15 1999). Mark. A. Graber MD, Mary Kathol MD 3. Special Thanks to: Dr. Sitton, John Larkin MS4 References