View source for Blunt neck trauma

==Background==
*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

==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:
**[[Spinal cord injury]]
**[[Vertebral and Carotid Artery Dissection]]
**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==
{{Blunt neck trauma DDX}}

===Other===
*[[Head trauma]]
*[[Thoracic trauma]]

==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===
[[File:Vertebral lines.png|thumb|Plain films lines]]
*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
**See the [[EBQ:Prehospital Spine Immobilization|NAEMSP National Guidelines for Spinal Immobilization]]
*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==
*[https://coreem.net/podcast/episode-173-0-blunt-neck-trauma/ Blunt Neck Trauma from CoreEM]

==References==
<references/>

[[Category:Trauma]]
[[Category:Orthopedics]]