Related Experiment Video
Updated: Jul 4, 2026
05:45
Expansion Duroplasty For Severe Cervical Spinal Cord Swelling After Traumatic Injury: A Step-by-Step Surgical Protocol
Published on: May 26, 2026
Clearing the cervical spine in obtunded patients
Tyler J Harris1, C Craig Blackmore, Sohail K Mirza
1School of Medicine, University of Washington, University of Washington School of Medicine, Seattle, WA 98104-2499, USA.
Spine
|June 17, 2008
Summary
Initial computed tomography (CT) effectively identifies cervical spine injuries in obtunded trauma patients. However, routine upright radiographs are unnecessary and delay patient care, missing no injuries.
Area of Science:
- Emergency Medicine
- Radiology
- Trauma Surgery
Background:
- Cervical spine injury clearance in obtunded blunt trauma patients lacks a standardized optimal method.
- Significant variation exists in trauma center spine clearance protocols.
Purpose of the Study:
- To determine the frequency of missed cervical spine injuries by initial computed tomography (CT) in obtunded blunt trauma victims.
- To evaluate the impact of subsequent imaging on spine clearance time.
Main Methods:
- Retrospective cohort study of obtunded blunt trauma victims undergoing initial cervical spine CT.
- Exclusion of patients with initial CT-identified injuries or those who became examinable before further imaging.
- Composite reference standard including subsequent imaging and clinical examination for injury diagnosis.
Main Results:
- Initial CT missed only 1 injury (0.3% false negative rate) in 367 patients.
- Subsequent upright cervical spine radiographs identified no additional injuries.
- Upright radiographs delayed spine clearance by a mean of 2.6 days, exceeding 48 hours in 42% of cases.
Conclusions:
- Initial CT imaging is highly accurate for identifying unstable cervical spine injuries in obtunded trauma patients.
- Subsequent upright radiographs are not beneficial for injury detection and significantly delay spine clearance.
Related Concept Videos
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
Airway management is a key skill in emergency and critical care settings, as maintaining a clear airway is essential for adequate oxygenation and ventilation.Head Tilt-Chin Lift TechniqueThe head tilt-chin lift maneuver is an essential technique primarily used in patients without suspected cervical spine injuries. To perform this maneuver, one hand is placed on the patient’s forehead, and gentle pressure is applied backward to tilt the head. The fingertips of the other hand are positioned under...
01:22Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
01:17Endotracheal Intubation II: Nursing Management
Endotracheal intubation is a critical procedure that can be lifesaving for many patients with respiratory distress or failure. The role of nursing in managing endotracheal tubes is pivotal, as it involves pre-intubation preparation, assisting during the procedure, and post-extubation care.
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
1. Nursing Care of Patients Before Intubation
Before the endotracheal intubation procedure, nurses play an essential role in ensuring the process goes smoothly. The nurses must be familiar with intubation...
01:22Stages of General Anesthesia
Various sedation levels offer significant advantages in facilitating procedural interventions for patients undergoing medical or invasive surgical procedures. These levels span from anxiolysis to general anesthesia, providing a spectrum of sedative effects to cater to specific patient needs. Anxiolysis reduces anxiety and is achieved through minimal sedation, enabling patients to remain awake and responsive while feeling more at ease during the procedure. This level can benefit minor...
01:26Tracheostomy Suctioning I: Pre-Procedural Steps
Tracheostomy suctioning is a critical procedure healthcare professionals perform to maintain a patent airway in patients with a tracheostomy tube. This procedure is necessary when secretions accumulate in the airway, causing respiratory distress. Here is a step-wise procedural guide for performing tracheostomy suctioning using an open system.
Equipment Required
First, gather all necessary equipment: a sterile suction catheter, a sterile disposable container, sterile gloves, a towel or...
Equipment Required
First, gather all necessary equipment: a sterile suction catheter, a sterile disposable container, sterile gloves, a towel or...
01:29Suctioning the Nasopharyngeal Airway
Nasopharyngeal suctioning is a procedure to remove secretions from the upper part of the respiratory tract that the patient cannot clear independently. It helps maintain airway patency and prevents complications such as aspiration pneumonia.
Equipment Required
Equipment Required