Clearing the cervical spine

WikiDoc Resources for Clearing the cervical spine
Articles
Most recent articles on Clearing the cervical spine Most cited articles on Clearing the cervical spine Review articles on Clearing the cervical spine Articles on Clearing the cervical spine in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Clearing the cervical spine Images of Clearing the cervical spine Photos of Clearing the cervical spine Podcasts & MP3s on Clearing the cervical spine Videos on Clearing the cervical spine
Evidence Based Medicine
Cochrane Collaboration on Clearing the cervical spine Bandolier on Clearing the cervical spine TRIP on Clearing the cervical spine
Clinical Trials
Ongoing Trials on Clearing the cervical spine at Clinical Trials.gov Trial results on Clearing the cervical spine Clinical Trials on Clearing the cervical spine at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Clearing the cervical spine NICE Guidance on Clearing the cervical spine NHS PRODIGY Guidance FDA on Clearing the cervical spine CDC on Clearing the cervical spine
Books
Books on Clearing the cervical spine
News
Clearing the cervical spine in the news Be alerted to news on Clearing the cervical spine News trends on Clearing the cervical spine
Commentary
Blogs on Clearing the cervical spine
Definitions
Definitions of Clearing the cervical spine
Patient Resources / Community
Patient resources on Clearing the cervical spine Discussion groups on Clearing the cervical spine Patient Handouts on Clearing the cervical spine Directions to Hospitals Treating Clearing the cervical spine Risk calculators and risk factors for Clearing the cervical spine
Healthcare Provider Resources
Symptoms of Clearing the cervical spine Causes & Risk Factors for Clearing the cervical spine Diagnostic studies for Clearing the cervical spine Treatment of Clearing the cervical spine
Continuing Medical Education (CME)
CME Programs on Clearing the cervical spine
International
Clearing the cervical spine en Espanol Clearing the cervical spine en Francais
Business
Clearing the cervical spine in the Marketplace Patents on Clearing the cervical spine
Experimental / Informatics
List of terms related to Clearing the cervical spine

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Clearing the cervical spine is the process by which medical professionals determine that cervical spine injuries do not exist. This process can take place in the emergency department or take place in the field by appropriately trained EMS personnel. It is based on the NEXUS (National Emergency X-Radiography Utilization Study) criteria.

Excluding a cervical spinal injury requires clinical judgement and training.

When a significant mechanism of injury is present, a cervical spine is determined to be stable if:

• There is no posterior midline cervical tenderness
• There is no evidence of intoxication
• The patient is alert and oriented to person, place, time, and event
• There is no focal neurological deficit
• There are no painful distracting injuries (e.g., long bone fracture)

If the patient does not meet all the above criteria then they require a three view cervical x-ray series, and thoracolumbar AP and lateral plain films.

If the patient has a head injury with altered sensorium, is intoxicated, or has been given potent analgesics, then the cervical spine must remain immobilised until the clinical examination becomes possible.

If the patient is not expected to be clinically evaluable within 48-72 hours because of severe head or multiple injuries, they should remain immobilized until a time when such an examination is possible. A high resolution CT (1.5-2 mm slices) with sagittal reconstructions is not a viable alternative, since it does not rule out ligamentous injury leading to instability.

Neurological deficit referable to the spine may require an urgent MRI scan.

Senior neurosurgeons or orthopaedic surgeons manage any detected injury. Today, most large centers have Spine Surgery specialists, that have trained in this field after their Orthopedic or Neurosurgical residency.

References

1. Morris CGT, McCoy E. Clearing the cervical spine in unconscious polytrauma victims, balancing risks and effective screening Anaesthesia, 2004, 59 pp 464–482