X-RAY VERSUS CT FOR TRAUMATIC PAEDIATRIC CERVICAL SPINE IMAGING: WHAT GUIDANCE DO CLINICANS HAVE?
Introduction:
Evidence shows that road traffic accidents are the most common cause of paediatric cervical spine (c-spine) injury, with many dying at the scene (Booth, 2012). On presentation to the hospital, assessment of the paediatric patient requires recognition of subtle signs and symptoms, often in the setting of distracting injuries (Jones, Anderson and Noonan, 2011). Since history taking from a paediatric trauma patient is especially difficult, clinicians may be forced to use imaging for full evaluation (Tepper, Brice and Hobgood, 2013). This is a difficult decision to make, and formal guidance is lacking (Booth, 2012).
With the
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Since high speed road traffic accidents are the most common cause of spinal injury in the under 8s (Egloff et al., 2009), clinicians should not be prudish in their approach to imaging.
On examination, she was moving all four limbs spontaneously, and there was no evidence of neurological deficit. However, she avoided head movement, choosing to look sideways with her eyes, and cried on palpation of her spinous processes. Marked soft tissue swelling on the neck and torso from the seat restraints was noted, along with a bruise on her cheek. Slack and Clancy (2004) state that patients with an injury above the clavicles and all patients involved in high speed vehicular accidents should be assumed to have a spinal injury.
Initially, a single view radiograph was requested to evaluate the potential injury findings. A horizontal-beam lateral was performed as it is the most sensitive view at 75% in the under 8s, and 93% in over 8s and may even suffice as a standalone projection (Ropele, Bleck and Vander Laan, 2009), which emphasises the importance of optimal imaging technique. The open-mouth odontoid images are difficult to acquire in young children due to poor compliance and should not be routinely performed (Agius et al., 2012).
The resultant image demonstrated a possible atlanto-axial instability with anterior dislocation of C1 (fig. 1(a)). According to (Booth, 2012), the anterior and posterior cervical and spinolaminar lines should be assessed (fig. 1(c)) recognizing that
In addition to this, a statement in the diagnostic summary under the x-Ray and MRI examination shows that his spinal cord was impacted more than his brain by stating that “No fractures present in the skull.” and “Fracture in the 7th cervical vertebra.” Furthermore, the central nervous system consists of the brain and the spinal cord, and these two systems are directly related. Signals are sent through the nerves in the spinal cord to communicate with the brain and vice versa. Therefore, it is extremely common that when an individual encounters an accident that the central nervous system as a whole is harmed. The brain and spinal cord work as a team, this does not mean that it is not possible that only one system is effected, I am just saying that it is very common/easy for both to be wounded at the same time. This knowledge is another reason why I strongly believe that Mike Smith has brain and spinal cord injury. However, if it were true that Mike only had a brain injury than the results would include something about his speech and memory loss being abnormal, along with no comments about his spinal cord. And on the other hand, if the diagnosis were to show only a spinal cord injury than his right eye would not have an abnormal pupil response nor would he show a
20. A patient was in an automobile accident and is complaining of a minor headache and no other apparent injuries. History gathered from bystanders states that the patient was not wearing a seat belt and hit his head on the windshield. A 15-minute loss of consciousness was noted. The patient was then admitted for 24-hour observation to rule out head injury. A comprehensive history and exam are performed by the physician. The MDM is of moderate complexity.
If we could give only one piece of advice to our West Boca Raton, FL patients who experience an auto accident, if would be to contact our Shadowood Chiropractic Center as soon as possible for a comprehensive exam. It’s true that whiplash is the most common injury associated with vehicular accidents,
More significantly, the witnesses said they were knowledgeable that the claimant was involved in a recent automobile accident when he injured his “spinal cord” during the car crash where he was transported to a local emergency room for his injuries. They said the accident occurred in November
Trauma one Pediatric Emergency Department! Trauma one Pediatric Emergency Department responding over! Rescue Unit 29 transporting a 12 year-old boy, named Mike, hit by a car while riding his bicycle. This is a hit and run accident, but other motorists called a rescue unit. The child was not wearing a helmet. Facial bleeding is under control, but he suffered facial and head trauma. There appeared to be no facture of the extremities. Presently he is awake and semi-alert. Vitals signs: BP 120/56, Pulse 120, Oxygen
The radiographer’s job is to deliverer quality X-rays that have been ordered by the medical staff. Basic radiographs required to exclude a cervical spine fracture include lateral view, anterioposterior view, and an open-mouth odontoid view. The lateral view must include all seven cervical vertebrae as well as the joint space between C7-T1. If this is not possible because of patient size or condition then a swimmers view will be needed. The anterioposterior view should show all cervical vertebrae, while the dens and joint space should be visible on the odontoid view. These exams need to be completed in a timely matter while continuing to maintain cervical immobilization. The importance of obtaining quality X-rays cannot be overemphasized as the most frequent cause of missed cervical fractures is the result of inadequate films.
paralyzed from the neck down as a result of a July 4, 1967 driving accident (Hodson). It
understanding of how much injury occurs to the brain and nervous system during impacted car
Traumatic brain injuries have become an epidemic, affecting both children and adults. The effects of these brain injuries are severe however; they do differ in severity from youth to adult age in areas such as: cognitive and speech function, physical ability, fatigue, and headaches. America has been recognizing the severity of these injuries and sports and medicine have increased funding to prevent them. In order to properly decide what treatment is best for adults or youth suffering traumatic brain injuries one must conclude the differences between adult and youth symptoms, this proves challenging because the amount of adults suffering traumatic brain injuries is much fewer than adolescents. Another challenge faced when attempting to record and prevent these injuries is the lack of knowledge of symptoms; youth often misinterpret concussion symptoms and believe they have learning disabilities such as ADD and ADHD.
CT scan of the cervical spine dated 01/07/14 revealed posterior fusion from C5 through C7. There is minimal anterior subluxation of C6 on C7.
Accident victims may be paralyzed or suffer permanent disabilities as a result of their injuries.
Spine injuries hurt a lot for example your spine can pop outback this up. 2-100,000 get spine injuries.
DOI: 9/18/2000. Patient is a 59-year-old female technician who sustained a work-related injury due to being jostled and jolted in the back of a golf cart which ran over a pothole. As per OMNI, she was diagnosed with post cervical protrusions, facet syndromes with headaches, lumbar facet syndrome and status post right shoulder repair/resection.
DOI: 6/23/2015. Patient is a 44-year-old male assembler who sustained injury while he was reaching for a part, pulled axle from rack and felt pain in the cervical spine. Per OMNI, the patient is diagnosed with acute cervical sprain and cervical radiculopathy.
According to Chiles and Cooper (1996) spinal injury should always be suspected in patients with severe systemic trauma, patients