Table of contents
Head Trauma
Canadian CT Head Rules High Risk Criteria
Medium Risk Criteria
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Clearing C-spine
Clear C-spine Rules:
- Must rule out bony and ligamentous injury
- Can clear clinicaly w/o xrays
- Cannot clear w xrays, w/o clinical exam b/c clinical exam is best for ligamentous injury
- Clinical clearance:
- N sensorium
- No head injuries, no intoxication
- No midline spine pain/tenderness
- Patient reported
- Palpate along spinal processes
- No neurologic signs/symptoms
- Check motor + sensory deficits
- No distracting injuries
- Severe pain elsewhere, does not pay attention to spine
- If all 4 cleared, try to take through ROM
- If all normal, do not need CT
- N sensorium
- Plain films:
- Hard to see upper/lower segments
- C6/7 – 2ndmost common injury esp. in muscular people
- Need Lateral + AP films, ensure visualize C1 and T1, can also shoot odontoid (C2), but not often.
- If cannot clear clinically:
- Leave collar on until wakes up (sometimes done)
- Take collar off and reapply if wakes up w/ pain or sx (most common)
- Dynamic flex/ext views (not done)
- MRI – not routine
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