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)