Neck Trauma

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#CC9900" TEXT="#080000" bgproperties="fixed" background="044005a0dwnjzk.png"> <div> <A HREF="index.htm" TARGET="_top" TITLE="TRAUMA SURGERY"><U><B>home</B></U></A><B>     | </B><B> </B><B> </B><B>  </B><FONT SIZE="5" COLOR="#FFCC66" FACE="Arial" ><B>TRAUMA SURGERY</B></FONT></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="compartment syndrome"><U><B>compartment syndrome</B></U></A><B>   |   </B><A HREF="id27.htm" TARGET="_top" TITLE="fasciotomy"><U><B>fasciotomy</B></U></A><B>   |   </B><A HREF="id28.htm" TARGET="_top" TITLE="Heel Spur Syndrome"><U><B>Heel Spur Syndrome</B></U></A><B>   |   </B><A HREF="id21.htm" TARGET="_top" TITLE="trauma management"><U><B>trauma management</B></U></A><B>   |   </B><B>Neck Trauma</B><B>   |   </B><A HREF="id23.htm" TARGET="_top" TITLE="Chest Trauma"><U><B>Chest Trauma</B></U></A><B>   |   </B><A HREF="id24.htm" TARGET="_top" TITLE="Abdominal Trauma in the Major Trauma Vic"><U><B>Abdominal Trauma in the Major Trauma Victim</B></U></A><B>   |   </B><A HREF="id25.htm" TARGET="_top" TITLE="Extremity Trauma"><U><B>Extremity Trauma</B></U></A><B>   |   </B><A HREF="id26.htm" TARGET="_top" TITLE="Airway Management and Rapid Sequence Int"><U><B>Airway Management and Rapid Sequence Intubation (RSI)</B></U></A><B>   |   </B><A HREF="id20.htm" TARGET="_top" TITLE="pelvic fracture surgery"><U><B>pelvic fracture surgery</B></U></A><B>   |   </B><A HREF="id18.htm" TARGET="_top" TITLE="Contact Me"><U><B>Contact Me</B></U></A><B>   |   </B><A HREF="id17.htm" TARGET="_top" TITLE="Related Links"><U><B>Related Links</B></U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Neck Trauma</div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="compartment syndrome"><U><B>compartment syndrome</B></U></A></div> <div> <A HREF="id27.htm" TARGET="_top" TITLE="fasciotomy"><U><B>fasciotomy</B></U></A></div> <div> <A HREF="id28.htm" TARGET="_top" TITLE="Heel Spur Syndrome"><U><B>Heel Spur Syndrome</B></U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="trauma management"><U><B>trauma management</B></U></A></div> <div> <B>Neck Trauma</B></div> <div> <A HREF="id23.htm" TARGET="_top" TITLE="Chest Trauma"><U><B>Chest Trauma</B></U></A></div> <div> <A HREF="id24.htm" TARGET="_top" TITLE="Abdominal Trauma in the Major Trauma Vic"><U><B>Abdominal Trauma in the Major Trauma Victim</B></U></A></div> <div> <A HREF="id25.htm" TARGET="_top" TITLE="Extremity Trauma"><U><B>Extremity Trauma</B></U></A></div> <div> <A HREF="id26.htm" TARGET="_top" TITLE="Airway Management and Rapid Sequence Int"><U><B>Airway Management and Rapid Sequence Intubation (RSI)</B></U></A></div> <div> <A HREF="id20.htm" TARGET="_top" TITLE="pelvic fracture surgery"><U><B>pelvic fracture surgery</B></U></A></div> <div> <A HREF="id18.htm" TARGET="_top" TITLE="Contact Me"><U><B>Contact Me</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Related Links"><U><B>Related Links</B></U></A></div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>Initial treatment.</B> Must immobilize neck and restrain chest if want to immobilize cervical spine. </div> <div> Sand bags not a good idea because, if want to turn patient on backboard, may fall against neck causing further injury. </div> <div> If strongly suspect C-spine injury and unable to restrain patient, consider paralysis (see section on <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>rapid sequence intubation</U></FONT>). </div> <div> Neutral position differs in adults and children. </div> <div> Children <8 years of age may require elevation of shoulders and back to approximate a neutral position. </div> <div> Adults and older children may require padding under the head to approximate a neutral position. </div> <div> Prolonged immobilization (even <30 minutes) on a backboard will cause most individuals to have occipital headache and lumbosacral pain regardless of underlying trauma. </div> <div> <B>Blunt injury</B> including falls and motor vehicle accidents: </div> <div> Have effectively ruled out a C-spine fracture if: </div> <div> Patient is not having neck pain. </div> <div> Does not have neck tenderness on exam. </div> <div> Has a normal mental status without loss of consciousness or use of drugs or alcohol on board. </div> <div> <B>AND</B> does not have another confusing variable such as severe pain elsewhere (such as an ankle fracture). </div> <div> To clinically clear the C-spine, all the above conditions must be met. All others require clearance of the C-spine by radiograph. These criteria have not been adequately tested in children. </div> <div> <B>X-ray approach.</B> </div> <div> Need five views, which include C7 to T1 to effectively rule out a C-spine fracture. The most common cause of missed C-spine injuries is an inadequate C-spine series. </div> <div> In ambiguous radiographic findings, CT may be helpful. </div> <div> Those with one spinal fracture have about a 10% chance of having another, noncontiguous, spine fracture and should have a full spine series. </div> <div> <B>Cord injuries.</B> </div> <div> Look for paralysis, other signs of cord injury including priapism, urinary retention, fecal incontinence, paralytic ileus, immediate loss of all sensation, and reflex activity below the level of the injury. </div> <div> Spinal neurogenic shock leads to vasomotor instability from loss of autonomic tone, may lead to hypotension or temperature instability. </div> <div> May get hypoxia, hypoventilation if above C5; consider intubation. </div> <div> "Spinal shock" is a separate, neurologic entity occurring as a result of cord injury, which presents with flaccid paralysis and usually recovers in hours to weeks. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Frequently occurs in children without associated C-spine fractures. <B>SCIWORA</B> syndrome = spinal cord injury without radiologic abnormality). </div> <div> Any person with a spinal cord injury should receive methylprednisolone 30 mg/kg bolus followed by 5.4 mg/kg/hr IV over the next 23 hours. This should be started within 8 hours of the injury. </div> <div> <B>Penetrating neck trauma.</B> Although management still controversial, "all" should be explored in OR. Do<B> not</B> remove foreign body until patient in OR. Consider CT/angiography if foreign body close to arterial blood supply. </div> <div> <B>Airway injuries.</B> </div> <div> <B>Clinical signs.</B> Stridor, hoarseness, dyspnea, subcutaneous emphysema. </div> <div> <B>Management.</B> ENT consultation, intubation orally if possible and if indicated. Avoid causing further trauma. </div> <bR> </td> </tr></table></body>