A 35-year-old transient man with a history of alcohol abuse is trying to jump from a moving train when his backpack is caught on the door. He falls out of the train and has an uncontrolled landing where he says that he hit his head. The patient arrives in the emergency department fully immobilized on a long board with a semi-rigid collar in place. He is complaining of leg pain but denies pain in his back or neck. His breathing is clear and his oxygen saturation is 99% of 1 L of oxygen. His blood pressure is 115/75 mm Hg, pulse 80 bpm, and respirations 15 breaths/min. His pupils are round and reactive to light and accommodation, and there is mild bruising over his left temple. His right leg is mildly tender at the knee joint. Which of the following is a contraindication to clearing the cervical spine and removing the collar without additional imaging?
- Bruising over the temple
- History of alcohol abuse
- Impaired motor function of his right knee
- Normal sensation and reflexes
- Presence of posterior midline tenderness
Trauma and Burns/Trauma/Spinal Injuries. Most trauma patients are suspected of having cervical spinal injury until proven otherwise. Cervical trauma often occurs from hyperflexion, hyperextension, vertical compression, or lateral rotation of the neck during an injury. It is possible that this patient injured his neck, and he should be checked for signs of spinal injury. Examination involves assessing midline tenderness, sensation, motor function reflexes, and performing a rectal exam. Exam findings that suggest spinal injury include pain with movement, tenderness, gaps or steps in the spine, edema or bruising over the spine, or spasm of associated muscles. Patients without these symptoms can be cleared, assuming other risk factors (such as increased age, mechanism of injury, falls greater than 1 m, axial loads on the spine, high speed, or dramatic injuries) are not present.
Ref-
Step-Up to Surgery
by Stanley Zaslau and Richard A. Vaughan
2nd edition published by Wolters kluwer
(Thanks to author&Publisher. The post is meant for MBBS students who aspire for PG seat by writing NEET 2014 This is a good book in Surgery)
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