Blunt neck trauma: Difference between revisions
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==Background== | ==Background== | ||
*Suspect vascular damage to cord if discrepancy between neuro deficit and level of spinal column injury | *Suspect vascular damage to cord, if discrepancy between [[Focal neurologic deficits|neuro deficit]] and level of spinal column injury | ||
*[[Spinal cord injury]] is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted | *[[Spinal cord injury]] is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted | ||
==Clinical Features== | ==Clinical Features== | ||
*Signs of life-threatening neck or upper thoracic injury (look for ''TWELVE'') | *Signs of life-threatening neck or upper thoracic injury (look for ''TWELVE''): | ||
''T''racheal deviation'' | :'''T'''racheal deviation'', | ||
''W''ounds | :'''W'''ounds, | ||
''E'' | :'''E'''xternal markings, | ||
''L''aryngeal disruption | :'''L'''aryngeal disruption, | ||
''V''enous distention | :'''V'''enous distention, | ||
''E''mphysema (surgical) | :'''E'''mphysema (surgical) | ||
*Features may include signs and symptoms of: | *Features may include signs and symptoms of: | ||
**[[Spinal cord injury]] | **[[Spinal cord injury]] | ||
**[[Vertebral and Carotid Artery Dissection]] | **[[Vertebral and Carotid Artery Dissection]] | ||
**Laryngeal or [[tracheal injury]] | **Laryngeal or [[tracheal injury]] | ||
===Pediatrics=== | |||
*In a small study of 42 patients with a cervical seatbelt sign there were no isolated cerebrovascular injuries. For pediatric patients in a motor vehicle collision, the presence of an isolated seatbelt sign was not associated with any cases of cerebrovascular injury. <ref>Desai NK, et al. Screening CT angiography for pediatric blunt cerebrovascular injury with emphasis on the cervical “seat- belt sign.” AJNR Am J Neuroradiol. 2014 Sep;35(9):1836-40. PMID: 24722311.</ref> | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
===Workup=== | |||
*Consider x-ray or non-contrast cervical CT to evaluate for bone/cord injury (see below) | |||
**May later consider cervical MRI to further evaluate for cord injury | |||
*Consider CTA neck with contrast to evaluate for vascular injury (see below) | |||
=== | ===General Approach=== | ||
*If concern for cervical spine injury, use a [[cervical spine clearance]] decision rule to determine need for imaging | |||
*Perform a neuro exam, to determine concern for [[spinal cord injury]] | |||
*If concern for vascular injury, use the [[Denver screening criteria]] | |||
* | |||
* | |||
==Management== | ==Management== | ||
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*Hospital | *Hospital | ||
**Secure ABCs | **Secure ABCs | ||
**See [[cervical spine clearance]] | |||
**See specific diagnosis | **See specific diagnosis | ||
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*[[Canadian cervical spine rule]] | *[[Canadian cervical spine rule]] | ||
*[[NEXUS cervical spine rule]] | *[[NEXUS cervical spine rule]] | ||
*[[Strangulation]] | |||
*[[Vertebral and carotid artery dissection]] | |||
==External Links== | |||
*[https://coreem.net/podcast/episode-173-0-blunt-neck-trauma/ Blunt Neck Trauma from CoreEM] | |||
==References== | ==References== | ||
Latest revision as of 12:51, 22 February 2020
Background
- Suspect vascular damage to cord, if discrepancy between neuro deficit and level of spinal column injury
- Spinal cord injury is more likely if anterior (vertebral bodies) AND posterior (spinal canal) columns are disrupted
Clinical Features
- Signs of life-threatening neck or upper thoracic injury (look for TWELVE):
- Tracheal deviation,
- Wounds,
- External markings,
- Laryngeal disruption,
- Venous distention,
- Emphysema (surgical)
- Features may include signs and symptoms of:
Pediatrics
- In a small study of 42 patients with a cervical seatbelt sign there were no isolated cerebrovascular injuries. For pediatric patients in a motor vehicle collision, the presence of an isolated seatbelt sign was not associated with any cases of cerebrovascular injury. [1]
Differential Diagnosis
Neck Trauma
- Penetrating neck trauma
- Blunt neck trauma
- Cervical injury
- Neurogenic shock
- Spinal cord injury
Other
Evaluation
Workup
- Consider x-ray or non-contrast cervical CT to evaluate for bone/cord injury (see below)
- May later consider cervical MRI to further evaluate for cord injury
- Consider CTA neck with contrast to evaluate for vascular injury (see below)
General Approach
- If concern for cervical spine injury, use a cervical spine clearance decision rule to determine need for imaging
- Perform a neuro exam, to determine concern for spinal cord injury
- If concern for vascular injury, use the Denver screening criteria
Management
- Prehospital
- Hospital
- Secure ABCs
- See cervical spine clearance
- See specific diagnosis
Disposition
- Based on specific diagnosis
See Also
- Penetrating neck trauma
- Cervical spine clearance
- Canadian cervical spine rule
- NEXUS cervical spine rule
- Strangulation
- Vertebral and carotid artery dissection
External Links
References
- ↑ Desai NK, et al. Screening CT angiography for pediatric blunt cerebrovascular injury with emphasis on the cervical “seat- belt sign.” AJNR Am J Neuroradiol. 2014 Sep;35(9):1836-40. PMID: 24722311.