Blunt neck trauma - Revision history

Danbot: Strip excess bold

2026-03-22T09:27:23Z

Strip excess bold

← Older revision		Revision as of 09:27, 22 March 2026
Line 5:		Line 5:
	==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'',		:Tracheal deviation'',
	:~~'''W'''ounds~~,		:Wounds,
	:~~'''E'''xternal~~ markings,		:External markings,
	:~~'''L'''aryngeal~~ disruption,		:Laryngeal disruption,
	:~~'''V'''enous~~ distention,		:Venous distention,
	:~~'''E'''mphysema~~ (surgical)		:Emphysema (surgical)
	*Features may include signs and symptoms of:		*Features may include signs and symptoms of:
	**[[Spinal cord injury]]		**[[Spinal cord injury]]

Rossdonaldson1: /* Evaluation */

2024-10-09T19:45:18Z

Evaluation

← Older revision		Revision as of 19:45, 9 October 2024
Line 33:		Line 33:

	===General Approach===		===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		*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]]		*Perform a neuro exam, to determine concern for [[spinal cord injury]]

Rossdonaldson1: /* Evaluation */

2020-02-22T12:51:55Z

Evaluation

← Older revision		Revision as of 12:51, 22 February 2020
Line 27:		Line 27:

	==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===		===General Approach===
	*If concern for cervical spine injury, use a [[cervical spine clearance]] decision rule to determine need for imaging		*If concern for cervical spine injury, use a [[cervical spine clearance]] decision rule to determine need for imaging

Rossdonaldson1 at 12:48, 22 February 2020

2020-02-22T12:48:24Z

← Older revision		Revision as of 12:48, 22 February 2020
Line 15:		Line 15:
	**[[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==
Line 28:		Line 31:
	*Perform a neuro exam, to determine concern for [[spinal cord injury]]		*Perform a neuro exam, to determine concern for [[spinal cord injury]]
	*If concern for vascular injury, use the [[Denver screening criteria]]		*If concern for vascular injury, use the [[Denver screening criteria]]

	~~===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>

	==Management==		==Management==

Rossdonaldson1: /* Evaluation */

2020-02-22T12:47:02Z

Evaluation

← Older revision		Revision as of 12:47, 22 February 2020
Line 24:		Line 24:

	==Evaluation==		==Evaluation==
			===General Approach===
	~~{{C-~~spine ~~NEXUS}}~~		*If concern for cervical spine injury, use a [[cervical spine clearance]] decision rule to determine need for imaging
	~~:^If find~~ injury ~~consider CT C-spine~~, ~~x-ray rest of~~ spine		*Perform a neuro exam, to determine concern for [[spinal cord injury]]
			*If concern for vascular injury, use the [[Denver screening criteria]]
	~~===~~[[~~Spinal~~ cord ~~trauma~~]]~~===~~
	*~~Neuro exam~~

	{{Denver ~~Screening Criteria}}~~

	===Pediatrics===		===Pediatrics===

Rossdonaldson1: /* Evaluation */

2020-02-22T12:33:18Z

Evaluation

← Older revision		Revision as of 12:33, 22 February 2020
Line 25:		Line 25:
	==Evaluation==		==Evaluation==

	~~===Fracture===~~
	{{C-spine NEXUS}}		{{C-spine NEXUS}}
	:^If find injury consider CT C-spine, x-ray rest of spine		:^If find injury consider CT C-spine, x-ray rest of spine

Rossdonaldson1 at 12:29, 22 February 2020

2020-02-22T12:29:14Z

← Older revision		Revision as of 12:29, 22 February 2020
Line 1:		Line 1:
	==Background==		==Background==
	~~[[File:Three-column-concept-2.jpg\|thumb\|Three column concept of spinal fracture stability]]~~
	*Suspect vascular damage to cord, if discrepancy between [[Focal neurologic deficits\|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

Rossdonaldson1: /* Evaluation */

2020-02-22T12:27:39Z

Evaluation

← Older revision		Revision as of 12:27, 22 February 2020
Line 33:		Line 33:
	*Neuro exam		*Neuro exam

	~~===[[Vertebral and Carotid Artery Dissection]]===~~
	{{Denver Screening Criteria}}		{{Denver Screening Criteria}}

Rossdonaldson1: /* Background */

2020-02-22T11:59:51Z

Background

← Older revision		Revision as of 11:59, 22 February 2020
Line 1:		Line 1:
	==Background==		==Background==
	*Suspect vascular damage to cord if discrepancy between [[Focal neurologic deficits\|neuro deficit]] and level of spinal column injury		[[File:Three-column-concept-2.jpg\|thumb\|Three column concept of spinal fracture stability]]
			*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

	~~[[File:Three-column-concept-2.jpg\|thumb\|Three column concept of spinal fracture stability]]~~

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: /* Clinical Features */

2020-02-22T11:59:14Z

Clinical Features

← Older revision		Revision as of 11:59, 22 February 2020
Line 6:		Line 6:

	==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''xternal markings,		:'''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]]