GRI ED
Immobilise the neck when there is a dangerous mechanism of injury (RTA, fallen from a height), or an unconscious patient with a head injury. Patients with a potential neck injury and a distracting injury or impaired cognition (either acute or chronic) should also be assumed to have sustained a significant neck injury until proven otherwise. Immobilise the neck with a semi-rigid collar + blocks and tape or by holding the head in a neutral position if intolerant of collar. A member of staff should stay with the patient, especially if at risk of vomiting. Supervise any movement required, eg logrolling, trolley transfer to radiology.
C Spine Injury
Warning
In the major trauma setting cervical spine X-rays are not usually performed as a CT scan is usually arranged, which provides better diagnostic accuracy. In other situations, the Canadian C-Spine Rule is applied to establish if XRay is required. (See wall flowchart and staffnet for pathway)
Essentially:
a) any High Risk Factor => x-ray
b) any Low-risk factor that allows safe assessment of neck range of motion – if then able to voluntarily rotate their neck 45o to each side => x-ray not required
c) Elderly patients image with CT in the first instance
Consult the flowchart to ensure the correct path is followed.
Patients with a significant 'distracting injury' and potential neck injury require imaging. Good quality radiographs are vital in the assessment of these patients. You must be able to see down to the C7/T1 junction. If this is unsuccessful, radiology will facilitate CT.
The interpretation of these X-rays can be difficult, so:
- Document the presence/absence of neck pain and indications for imaging/not imaging
- Ask a senior member of the ED Staff or a Radiologist if in any doubt.
- N.B Be aware of the possibility of a C2/peg # in the elderly or rheumatoid patient who has fallen and sustained an impact above the clavicles (even if just fallen out of a chair).
Equally falls from standing constitute “major trauma mechanisms” in the elderly and should be investigated accordingly.
View clinical guideline: See Imaging of a Potential Neck Injury, Glasgow Royal Infirmary Emergency Department (005)