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  #1  
Old 02-14-2012
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Emergency What to do with this neck collar!

A 24-year-old woman presents to the emergency department after being involved in a motor vehicle accident. She is moving all extremities and is conversant. She indicates that while driving at 30 mph, she veered off the road to avoid an oncoming car and crashed into a guard fence. Her airbag deployed, and she denies losing consciousness. She was placed in a stabilization collar in the fi eld. In the emergency department she complains of some minor cuts on her face and arms as well as neck pain. Her temperature is 37.2C (99.0F), blood pressure is 134/80 mm Hg, pulse is 90/min, and respiratory rate is 12/min. On examination she is alert and oriented, and extraocular movements are intact. Her pupils are equally round and reactive to light. She has full strength and sensation in her face and extremities. Neck examination reveals diffuse soreness posteriorly but no midline tenderness. There are no dislocations or step-offs. Breathalyzer test and urine toxicology screen are negative.
What is the most appropriate next step in management?

(A) Halo placement
(B) High-dose corticosteroids
(C) Lateral x-ray of the cervical spine with flexion and extension
(D) MRI of the cervical spine
(E) Remove collar and allow patient to slowly flex, extend, and rotate neck
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  #2  
Old 02-14-2012
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is it D...MRI of cervical spine???
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  #3  
Old 02-14-2012
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i did that too...it was wrong
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  #4  
Old 02-14-2012
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then other thing i can think of is high dose steroid...
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  #5  
Old 02-14-2012
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I think high dose steroid B.........
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  #6  
Old 02-14-2012
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E ????? .....
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  #7  
Old 02-14-2012
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The answer is E.
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  #8  
Old 02-14-2012
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What about the "C"

As a rule, she should not take the collar of unless "Radiologist" confirms that she has not cervical problem/fracture/sublaxation.

Though I am not 100% sure if neck movements are free allowed.

Steroids are given in emergency to avoid immenent damage.

MRI is time consuming.

Moving neck without clearance from Radiologist could prove dangerous.

Under these situation..."C" seems good guess to me.
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  #9  
Old 02-14-2012
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Quote:
Originally Posted by witecloud View Post
The answer is E.
yes, its E. how u say that? whats the logic behind?
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  #10  
Old 02-14-2012
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where did u find this question
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  #11  
Old 02-15-2012
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Quote:
Originally Posted by qurat21 View Post
where did u find this question
FA Q&A for the CK
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  #12  
Old 02-15-2012
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well, there it is. indications for neck collar in a patient with neck pain post accident are
1. local tenderness
2. focal deficit
3. local deformity

since she has nothing. she does not need collar. very absurd logic what i think...any comments???
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  #13  
Old 02-27-2012
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You are corrct.

She does not have any indication for collor because there is no local tenderness, strength is ok, no focal deficint is elicited. Just diffuse soreness or pain is not an indication of collar.

I think it is our "extended fear" which confuses us sometimes.

Thanks.
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  #14  
Old 02-27-2012
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C-spine imaging criteria:

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