Advanced Trauma Life Support ATLS Student Course Manual 2018

RADIOGRAPHIC EVALUATION 139
Penetrating Injuries
Penetrating injuries often result in a complete neurological
deficit due to the path of the missile involved
(most often a bullet or knife). These deficits also can
result from the energy transfer associated with a highvelocity
missile (e.g., bullet) passing close to the spinal
cord rather than through it. Penetrating injuries of the
spine usually are stable unless the missile destroys a
significant portion of the vertebra.
Blunt Carotid and Vertebral Artery
Injuries
Blunt trauma to the neck can result in carotid and
vertebral arterial injuries; early recognition and
treatment of these injuries may reduce the patient’s
risk of stroke. Specific spinal indications in screening
for these injuries include C1–C3 fractures, cervical spine
fracture with subluxation, and fractures involving the
foramen transversarium.
RadiogRAphic Evaluation
Both careful clinical examination and thorough
radiographic assessment are critical in identifying
significant spine injury.
Cervical Spine
Many trauma patients have a c-collar placed by emergency
medical services (EMS) in the field. Current
guidelines for spinal motion restriction in the
prehospital setting allow for more flexibility in the
use of long spine boards and cervical collars. With
the use of clinical screening decision tools such
as the Canadian C-Spine Rule (CCR; n FIGURE 7-8) and
the National Emergency X-Radiography Utilization
Study (NEXUS; n FIGURE 7-9), c-spine collars
and blocks may be discontinued in many of these
patients without the need for radiologic imaging.
n FIGURE 7-8 Canadian C-Spine Rule. A
clinical decision tool for cervical spine
evaluation. MVC = motor vehicle collison;
ED = emergency department. Adapted from
Stiell IG, Wells GA, Vandemheen KL, et al.
The Canadian C-Spine rule of radiography
in alert and stable trauma patients. JAMA
2001;286:1841–1848.
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