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Emergency Care/ Injuries and Poisonings

Cervical Spine Injuries

Wound Management

Bites and Stings

Minor Burns

Seizures

Gastrointestinal Decontamination

Cervical Spine Injuries

· Uncommon in children

· Higher fulcrum in children causes most injuries to be upper C-spine

· "Adult" pattern of injury occurs after 8 years of age

Evaluation

· Clinical "clearing" of C-spine Injuries

· Normal level emergency care, poisonings, cervical spine, bites, stings of consciousness

· Normal neurological examination

· No neck pain

· No neck tenderness

· No "distracting" injury, such as an abdominal injury

· Full voluntary range of motion

Radiographic Evaluation of Cervical Spine Injuries

· Lateral

· Anteroposterior

· Open-mouth odontoid view

- Flexion/extension views, CT scan, MRI as needed

Cervical Spine Injuries Interpretation of Radiographs

· C2-3 pseudosubluxation increases with neck flexion

· Radiolucent cartilage and greater recoil to normal position after fracture makes interpretation of pediatric C-spine radiographs challenging

· Spinal cord injury without radiographic abnormality

Management of Cervical Spine Injuries

· Support Airway, Breathing, and Circulation

· Immobilize the cervical spine in all children with suspected C-spine injury to prevent secondary injury

· Optimal immobilization requires stiff collar and spine board with shoulder mattress pad or occipital recess

Wound Management--Lacerations

General Principles

· Support Airway, Breathing, Circulation