I-C: FOOTNOTES: CERVICAL SPINE CLEARANCE

1. Requires 3 view C-Spine series at a minimum: A) lateral (Caudal Traction should be applied to the patients arms routinely). Need to see C7-T1 interspace. May need swimmers view if inadequate. B) an AP. C) open mouth odontoid; due to the difficulty in visualizing C1 and C2 on the open mouth odontoid view in intubated patients, a CT scan of C1-C2 should routinely be obtained along with admission head CT on all intubated patients.

2. Ligamentous injury must be ruled out in these patients at some point during hospitalization. Ideally, this should be accomplished when the patient is awake and alert enough to cooperate with an examination and subsequent active flexion extension views, if indicated. Until this can be accomplished, patients should be maintained in a hard collar (i.e. Philadelphia collar) until ligamentous injury has been ruled out.

3. Confrontational exam, in order to remove cervical collars, must be performed on awake and non-distracted patients. In the circumstance where this cannot be obtained, please follow the “obtunded patient” pathway of the cervical spine clearance algorithm.

4. A distracting injury refers to any injury to the head, chest, abdomen, or skeleton (spine, pelvis, extremities) which, in the opinion of the Trauma Attending, may possible preclude the patient’s ability to reliable perceive cervical spine tenderness during palpation and/or range of motion maneuvers. This is a clinical determination, which takes into account not only the magnitude of the extra spinal injuries but, more importantly, the patient’s ability to accurately discriminate cervical spine tenderness in the midst of extra cervical injuries. The decisions to clear a cervical spine in the presence of major extra spinal injuries must be documented in the patients Medical Record by the responsible Trauma Attending.

5. After clearing a patient’s cervical spine for collar removal a note should be documented in the patient’s Medical Record regarding the results of the examination and the fact that the collar was removed.