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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.

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ED trauma meeting 26 th July 2012 C spine Bonanza

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  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

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