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Trauma in the Elderly
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Degenerative changes make the neck less flexible and able to withstand trauma. Cervical spine fracture and cervical cord injury in the elderly carry a poor prognosis, with 56% having poor outcome and 25% mortality.28 Age is recognized as an independent risk factor for injury and a low threshold for imaging should be adopted.29 Plain X-rays are unreliable, and a low threshold for CT scanning is appropriate.30 A particular problem is cervical cord injury as a result of a hyperextension injury.
Upper Airway Obstruction and Tracheostomy
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
The usual route of intubation is via the mouth. This can be assisted by video-laryngoscopic devices.6 The relative contraindications include cervical spine fractures, severe facial trauma and laryngeal trauma. In cases of cervical spine fracture, great care must be taken to avoid neck extension that may precipitate or worsen spinal cord injury. Facial trauma is usually associated with increased difficulty visualizing the larynx due to oedema, mucosal laceration and bleeding, trismus and bony instability. Great care is needed where there is laryngeal trauma, as the act of intubation may worsen the existing damage.
Musculoskeletal cases
Published in Lt Col Edward Sellon, David C Howlett, Nick Taylor, Radiology for Medical Finals, 2017
Evaluation of the cervical spine XR in trauma involves searching for malalignment, cortical fracture, and soft tissue swelling.The standard radiographic views are the lateral, AP, and peg views. Remember to review all of these. You are very unlikely to be asked to report a cervical spine XR in an exam at finals but you do need to understand the principles. You would always ask for senior help andwould not ‘clear’ a spine XR on your own (you should not do this as a FY1/FY2 either!).Check for adequate spinal coverage. You must be able to see from the craniocervical junction down to T1 on the lateral view for the XR to be adequate. In this case C7 is labelled but not well seen. C7/T1 is where most fracture/dislocations occur and must be clearlyvisualised on XR to ensure normal alignment.Check for vertebral alignment on the lateral view (Figure 8.1C). Review the anterior vertebral line (A – the line of the anterior longitudinal ligament), the posterior vertebral line (B – the line of the posterior vertebral ligament), and the spinolaminar line (the line formed by the anterior margin of the spinous processes – C) plus line D (tips of spinous processes). These lines should be continuous, without any steps.Check the outline of each bone for fractures.Check the disc spaces. These should be approximately equal in height.Check the prevertebral soft tissues for haematoma and swelling:In adults, above C4, the prevertebral soft tissues should measure less than one-third of the width of the vertebral body. Below C4 these should measure less than the width of the vertebral body.There are many patterns of cervical spine fracture and these are usually classified according to the mechanism of injury (i.e. excess flexion, extension, or rotation).What further imaging could be performed?
Cerebrospinal fluid leak management in anterior basal skull fractures secondary to head trauma
Published in Neurological Research, 2022
Jian-Cheng Liao, Buqing Liang, Xiang-Yu Wang, Jason H. Huang
Classic clinical signs supporting the diagnosis of anterior fossa skull fractures include periorbital ecchymoses (raccoon eyes), epistaxis, CSF rhinorrhea, and cranial nerve palsies. It is important to note that these signs often appear several hours post-injury. The clinical diagnosis of CSF leaks is typically fairly obvious if clear fluid emanates from the nasal passage; however, confirmatory tests should be performed for verification. Facial trauma often coexists with injury to the cervical spine, cranial nerves, and internal carotid artery. In a study of 4,786 patients with craniofacial injuries, approximately 10% had a concomitant cervical spine fracture with a 2% dislocation rate [2]. The study reported that the upper face was associated with injuries to the mid to lower cervical spine and cranium, while mandible and midface injuries were associated with fractures of the upper cervical spine and basilar skull. The most commonly injured cranial nerve (CN) in frontobasal fractures is CN I, with resultant anosmia. Other CN dysfunctions can occur in 5% with variable recovery. Carotid artery injury occurs in approximately 2% in the setting of skull base fracture [8].
New Immobilization Guidelines Change EMS Critical Thinking in Older Adults With Spine Trauma
Published in Prehospital Emergency Care, 2018
Linda Underbrink, Alice “Twink” Dalton, Jan Leonard, Pamela W. Bourg, Abigail Blackmore, Holly Valverde, Thomas Candlin, Lisa M. Caputo, Christopher Duran, Sherrie Peckham, Jeff Beckman, Brandon Daruna, Krista Furie, Debra Hopgood
In our study, the overall cervical cord injury rate of 5.9% is lower than one may expect. Previous studies from around the world have reported wide ranges of cervical cord injuries. At a trauma center in Iran, only 3.6% of patients admitted with cervical spine injuries had a cord injury (21). A trauma center in Oslo, Norway, reported that 10% of patients with a cervical spine fracture had a spinal cord injury (22). In contrast, a multicenter European study and a Canadian study found that approximately 23% of patients with a cervical spine trauma sustained a cervical cord injury (23, 24). In multivariate analysis, Hasler et al. found increasing age, being male, and having a GCS score less than 15 were all associated with a higher risk of cervical cord injury. In addition, the mechanisms of injury most associated with cervical cord injuries were sports, followed by motor vehicle accidents and falls from more than 2 meters (23). Our study only included patients ≥60 years. Although Hasler et al. found an increase in the risk of cord injury with age, Jackson et al. reported that the proportion of patients ≥65 in the National Spinal Cord Injury Database was 8.5%, whereas 51.6% were 16 to 30 years and 24.1% were 31 to 45 years (23, 25). In addition, nearly half of our study population was female, the primary cause of injury was falls (65%), and 72% of the population had a GCS score of 15. The low rate of cord injury observed in our study may be due to the demographics and injury characteristics of our study population.
Association of helmet use with traumatic brain and cervical spine injuries following bicycle crashes
Published in British Journal of Neurosurgery, 2020
Paul S. Page, Daniel J. Burkett, Nathaniel P. Brooks
In the un-helmeted group, four patients (2.7%) had a cervical spine fracture compared with 12 (8.7%) helmeted patients, which was significant (p = 0.037) (Table 3). No association was found between cervical spine fracture level and helmet use (p = 0.138). Cervical strain was found to be more common in the un-helmeted group, occurring in 12 patients compared to three in the helmeted group. No difference was found in the likelihood of suffering a ligamentous injury, cord contusion, or nerve root injury (p > 0.05). Evaluation of the American Spinal Injury Association (ASIA) scores at the time of discharge demonstrated no statistically significant difference in neurologic outcomes with the majority of patients having no neurologic deficit (Table 4).