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Emergency Department Management of Cervical Spine Injuries (Trauma CME)
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Publication Date: October 2021 (Volume 23, Number 10)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I credits, 4 AAFP Prescribed credits, and 4 AOA Category 2-A or 2-B CME credits. CME expires 10/01/2024.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits, subject to your state and institutional approval.

Author

Geoffrey Jara-Almonte, MD
Assistant Residency Director, Department of Emergency Medicine, NYC Health + Hospitals/ Elmhurst Hospital Center, Icahn School of Medicine at Mount Sinai, New York, NY
Chandni Pawar, MD
Mount Sinai Hospital Emergency Department, New York, NY

Peer Reviewers

Michael Abraham, MD, MS, FAAEM
Adjunct Assistant Professor of Emergency Medicine, Department of Emergency Medicine, University of Maryland Medical Center, Baltimore, MD
Jared Ham, MD
Department of Emergency Medicine, Department of Neurology and Neurocritical Care, University of Cincinnati Medical Center, Cincinnati, OH

Abstract

The majority of the nearly 18,000 new cases of spinal cord injury in the United States each year involve the cervical spine. Although the morbidity, mortality, and healthcare costs associated with these injuries is very high, quality evidence to guide emergency management is limited. Recent changes to guidelines have called into question decades of practice, including prehospital spinal immobilization protocols, timing of surgery, and pharmacotherapy. A systematic approach to the diagnosis and management of the spine-injured patient is outlined in this review, with a focus on recent updates and management of emergent complications.

Case Presentations

CASE 1
EMS calls to alert you that they have 24-year-old man with head trauma, and they are 15 minutes out…
  • EMS says the man was found down on the street.
  • He has head trauma and a GCS score of 7, but his vital signs are normal.
  • You anticipate that this patient will need intubation. The EMS crew asks whether they should intubate in the field and whether he requires spinal immobilization...
CASE 2
A 64-year-old man walks into the ED complaining of left-sided neck pain after he was in a head-on motor vehicle crash several hours ago…
  • A resident is examining the patient, who said he was a restrained driver in the MVC, and the airbags did not deploy. He was ambulatory at the scene, and refused to go to the ED at that time, but now complains of left-sided neck pain.
  • On exam, he has left-sided paraspinal tenderness to palpation over the cervical and lumbar spinal area without step-offs or deformity. No neurological deficits are noted on exam.
  • The resident asks you whether the patient should be placed in a hard collar and whether imaging is appropriate…
CASE 3
A trauma is called overhead: a young woman was thrown from a horse onto her head and back…
  • You run to the trauma bay where the young woman has been brought in by EMS. The trauma resident is evaluating her ABCs.
  • You see that the patient is awake, has a GCS score of 15, and is answering questions appropriately, but she appears uncomfortable.
  • Her blood pressure on the monitor is 80/48 mm Hg. As the resident finishes the primary survey, you note that the patient is unable to lift her lower extremities on command. Her grip strength is weak, and she has gross loss of sensation in the bilateral upper extremities.
  • You wonder whether this is a head or a spine injury, and how best to treat her hypotension. Should she receive corticosteroids?

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