Cervical Spine Assessment in Children19 May, 2011 by: colinparker
Neck Injuries in kids are fortunately quite uncommon, but the assessment of a child with a potential cervical spine injury remains stressful and challenging. No-one wants to miss a broken neck… Because of the anatomical, physiological and behavioural differences, we can’t just do what we do for adults either.
How common is SCIWORA? How aggressively do we need to apply immobilisation and spinal boards? What does it mean to ‘clear’ the C-Spine? And who needs an X-Ray? Hop on board as we try to answer these tricky little questions…
PEMcast outline: C-Spine Assessment
[CP] Welcome, introductions (incl KW Adult trauma experience), disclaimer
[CP] Intro – incidence, structures that get damaged
[KW] SCIWORA – commoner in kids? Pang & Wilberger 1982
[KB] “Clearance” – what does it mean?
[CP] Resuscitation / life threats first
[KW] Immobilisation: who? How? Spinal boards…
[KB] analgesia options (& tips)
[CP] History esp mechanism of injury
[KW] Examination (ABCDE, Neuro, Musculoskeletal)
[KB] Who to image? NEXUS
[CP] Xrays & ?flexion-extension views
[KW] CT scan ?skip X-Rays, straight to CT if definitely need head CT?
[[KB] use of MRI
Assessing C-Spine X-Rays:
[CP] Adequacy & alignment (incl pseudo-subluxation reference Slack 2004 – confusing)
[KW] Bones & cartilage
[KB] Soft tissues – do you use 3/7/21mm etc?
[CP] removing the collar
[KW] “Clearing” the C-spine: Injury identified vs “all seems fine”
[KB] Ongoing suspicion & unconscious patients
[ALL] What about the very young patient? Pre-verbal, ‘uncooperative’, but lower risk of serious injury –
personal tips / strategies
[CP] RCH Melbourne CPG compared to PMH Guideline
[ALL] Summary, goodbye
Pang D, Wilberger JE Jr.
Spinal cord injury without radiographic abnormalities in children.
J Neurosurg. 1982 Jul;57(1):114-29. PubMed PMID: 7086488
Slack SE, Clancy MJ.
Clearing the cervical spine of paediatric trauma patients. Emerg Med J. 2004 Mar;21(2):189-93. Review. PubMed PMID: 14988345