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cervical spine (C-spine) clearance
Radiology:
- plain film of cervical spine may be prudent
- if NEXUS criteria or Canadian C-spine rule negative, CT is not necessary [2]
- CT of cervical spine if patient is obtunded [5]
- MRI not cost-effective if CT is negative [5]
Management:
1) the patient must be awake & lucid
2) negative cervical spine X-rays
3) assess for paresthesias, sensory loss
4) assess for muscle weakness
5) palpate C-spine
a) assess for bone pain
b) muscle pain not as important
6) move head from side to side
7) touch chin to chest
8) neck extension
Related
Canadian C-spine rule
cervical spine (C-spine)
NEXUS Criteria
General
clinical procedure
References
- Harrison's Principles of Internal Medicine, 13th ed.
Isselbacher et al (eds), McGraw-Hill Inc. NY,
1994, pg 79-80
- Schuur JD et al.
A top-five list for emergency medicine: A pilot project to
improve the value of emergency care.
JAMA Intern Med 2014 Feb 17
PMID: 24534899
http://archinte.jamanetwork.com/article.aspx?articleid=1830019
- MD+CALC: NEXUS Criteria for C-Spine Imaging
http://www.mdcalc.com/nexus-criteria-for-c-spine-imaging/
- Stiell IG et al
The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria
in Patients with Trauma.
N Engl J Med 2003; 349:2510-2518
PMID: 14695411
http://www.nejm.org/doi/full/10.1056/NEJMoa031375
- Wu X, Malhotra A, Geng B et al
Cost-effectiveness of Magnetic Resonance Imaging in Cervical
Clearance of Obtunded Blunt Trauma After a Normal Computed
Tomographic Finding.
JAMA Surg. 2018 Mar 14.
PMID: 29541757
- Patel MB, Como JJ, Haut ER.
The Devil Is in the Details When Removing Cervical Collars After Blunt Trauma.
JAMA Surg. 2018 Mar 14.
PMID: 29541768