Podcast
Questions and Answers
What additional diagnostic tool is recommended for major trauma victims to evaluate potential C-spine injuries?
What additional diagnostic tool is recommended for major trauma victims to evaluate potential C-spine injuries?
Which of the following statements about NEXUS criteria is true?
Which of the following statements about NEXUS criteria is true?
What is one of the Canadian C-spine rule questions that eliminates the need for radiographic studies?
What is one of the Canadian C-spine rule questions that eliminates the need for radiographic studies?
What clinical findings suggest a low probability of a C-spine injury in an injured patient?
What clinical findings suggest a low probability of a C-spine injury in an injured patient?
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Under which circumstance are children considered free of C-spine injury?
Under which circumstance are children considered free of C-spine injury?
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Which aspect of the Canadian C-spine rule is said to be more reliable than the NEXUS criteria?
Which aspect of the Canadian C-spine rule is said to be more reliable than the NEXUS criteria?
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What does the absence of clinical findings suggest regarding C-spine injuries in pre-elementary schoolchildren?
What does the absence of clinical findings suggest regarding C-spine injuries in pre-elementary schoolchildren?
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What is one limitation of the NEXUS criteria highlighted in the diagnosis of C-spine injuries?
What is one limitation of the NEXUS criteria highlighted in the diagnosis of C-spine injuries?
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Study Notes
C-Spine Injury Diagnosis in Trauma Patients
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NEXUS Criteria Limitations: The NEXUS criteria, while helpful for identifying low-risk patients for C-spine injury, frequently fail to detect clinically important unstable C-spine injuries in major trauma patients. A significant number of patients who initially passed NEXUS criteria were subsequently found to have serious C-spine injuries.
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NEXUS Criteria: The NEXUS criteria are based on a clinical evaluation for patients without posterior midline neck tenderness, focal neurologic deficits,intoxication, and distracting injuries. A normal level of alertness is also required.
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Difficulties with Distraction Injuries: A major contributing factor in the lower reliability of the NEXUS criteria is the difficulty of accurately identifying and assessing the severity of distracting injuries.
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Canadian C-spine Rule: This rule aims to reduce unnecessary radiography by identifying low-risk patients.
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Canadian C-spine Rule Criteria: The rule outlines three key questions to reduce C-spine radiography for low-risk patients.
- Are there high-risk factors requiring radiography?
- Are there low-risk factors allowing for safe neck range-of-motion assessment?
- Can the patient rotate their neck 45 degrees laterally without pain?
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Canadian Rule vs. NEXUS: The Canadian C-spine rule is demonstrably more reliable than NEXUS in diagnosing C-spine injury in conscious patients.
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Absence of Clinical Findings: Patients without neck pain, tenderness, or upper extremity paresthesia, especially if no distracting pain is present, are often considered at low risk for C-spine injury.
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Pre-elementary Schoolchildren: Absence of clinical findings (symptoms), is also a strong indicator for pre-elementary school children. This eliminates the need for diagnostic studies (and radiation exposure).
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Children with Persistent Midline Neck Pain: Children with sustained midline neck pain, in the absence of other symptoms, and negative initial imaging are also at very low risk for unstable C-spine injury.
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Description
This quiz explores the NEXUS Criteria and the Canadian C-spine Rule, highlighting their limitations in diagnosing C-spine injuries in trauma patients. It emphasizes the challenges in identifying distracting injuries that can affect clinical evaluations. Test your knowledge on these critical assessment tools and their implications in emergency care.
