1 / 65

ED trauma meeting 26 th July 2012 C spine Bonanza

ED trauma meeting 26 th July 2012 C spine Bonanza. Trauma Summary :June Snapshot. 114 Alerts 6 Responds 19 Missed activations. 2 needed urgent intervention. Overall Disposition: ICU 7 OT 7 THDU 10 NHDU 2 IR 1 ward 35.

emiko
Download Presentation

ED trauma meeting 26 th July 2012 C spine Bonanza

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. ED trauma meeting 26th July 2012 C spine Bonanza

  2. Trauma Summary :June Snapshot 114 Alerts 6 Responds 19 Missed activations 2 needed urgent intervention Overall Disposition: ICU 7 OT 7 THDU 10 NHDU 2 IR 1 ward 35 More than half are admitted; 20% are sick

  3. First half 2012 …. so far 2012 728 alerts 46 respond

  4. Case 1I think you call this a clusterf***1004917

  5. Prehospital Monday 4th June 08:45 M struck by motorcyclist who lost control of his bike I boneprotruding (L) lower leg S alert, HD stable decreased pulses in foot TKetamine 100mg, morphine 10mg # reduced and splinted, soft collar

  6. Emergency Dept 10:17 Airway & Breathing ✔ Circulation ✔ Disability ✔ Clinically Head, Neck, Abdo & pelvis – fairly unremarkable Predominately lower limb issues: • L)leg deformed ankle, sml 2mm open wound neuro/vasc intact • R) leg abrasion over medial ankle + lower leg

  7. CXR

  8. L lower limb

  9. Initial ED management

  10. Orthopaedic ward 10/5 Physio notes C-spine limited right rotation & lateral flexion (suggest stretches for C-spine) 11/5 C/O pins & needles in R) index + mid fingers Care transferred to plastics 18th May

  11. Plastics ward • 18/5 OT: free flap to L) lower leg • 19/5 ↓ SpO2 85% RA, seen by ward call • 20/5 CTPA : no PE, # 8th rib  seen by plastics reg C-spine Xray (to investigate paraesthesiae) ortho review suggesting CT spine (shooting pain shoulder/neck)

  12. CT C-spine

  13. Back to orthopaedic ward • 22/5 Tertiary Survey  XR R) ankle  medial malleolus # • 26/5 OT  ACDF C6-C7 + R) medial malleolus ORIF • 13/6 Discharged home Day 28

  14. Clinically clearing a C-spine How do you do it?? Do decision rules help??

  15. NEXUS34069 patients (included children)99% sensitivity Virtually no risk of C-spine injury if: NEXUS criteria met: • No neurology, normal alertness • Not intoxicated • No midline tenderness • No distracting painful injury

  16. What is a distracting injury? What does NEXUS say???

  17. Canadian C-spine Rule8924 adult patients100% sensitivity

  18. Now we have decided to do an Xray ……How do we interpret it?

  19. Anatomy refresher: C1 anatomy

  20. C2 anatomy

  21. C4 anatomy

  22. Lateral view

  23. Adequacy 2 3 4 5 6 7

  24. Lines Anterior Vertebral Line

  25. Lines Posterior Vertebral Line

  26. Lines Spinolaminal Line

  27. Lines Posterior Spinous Line

  28. Spaces Pre-dental space < 5mm children < 2.5mm adults

  29. Soft tissue < ⅓ width of C2 < full width of C7

  30. Peg view

  31. Check bony landmarks

  32. Symmetry of lateral dens space

  33. Check the lateral tips of C1

  34. Some abnormal C spines

  35. Case 2Thank God for Short Stay196315

  36. CT head

  37. CT C-spine

More Related