C-Spine Trauma

Step 1: Protect the Spine



* Apply cervical collar



Step 2: Apply NEXUS Criteria



* Use the “SPINE” mnemonic* Spinal midline tenderness* Painful distracting injury* Intoxication* Neurologic deficit* Encephalopathy



Step 3: If Patient Has None of the NEXUS Criteria… You Are Done!



Step 4: If Patient Has Positive NEXUS Criteria…



* Obtain CT scan of the cervical scan without contrast



Step 5: Clear the C-Spine



* If CT scan negative -> Have patient turn head 45 degrees to right and left* If patient has no limitation and no paresthesias or neurologic deficit…* Remove collar* If still concerned for spinal injury despite normal CT* Keep collar on and have patient follow up in clinic for reexam



Unstable Cervical Spine Fractures



* Mnemonic: Jefferson Bit Off a Hangmans Tit* Jefferson fracture* Bilateral facet dislocation* Odontoid fracture* Atlantooccipital dislocation* Hangman’s fracture* Teardrop fracture



Additional Reading



* NEXUS Criterial for C-Spine Imaging (MDCalc)* Unstable Spine Fractures (WikEM)