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SAQ 186 – Trauma – unstable cervical spine injury and transfer

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Marked out of 12.00

A 25-year-old man presents to a rural emergency department after falling from a motorbike. He has neck pain, GCS 15, and an isolated neck injury. His cervical-spine x-ray is shown below.

Cervical spine x-ray for Geelong SAQ 021 question 2 — Cervical spine x-ray

State three (3) abnormal findings shown in this x-ray.

(Marked out of 3.0)

/ 3

He requires road transfer to a trauma centre 150 km away. State six (6) transfer preparations specific to this injury.

(Marked out of 6.0)

/ 6

List one (1) pro and two (2) cons of using steroids for this patient.

(Marked out of 3.0)

/ 3

Total Score: 0 / 12

Percentage: 0%

Model Answer

Question 2. unstable cervical spine injury and transfer.

a. X-ray findings

Anterior teardrop fracture of C5.
Posterior teardrop fracture of C5.
Loss of continuity of the posterior spinal line at C5-C6.
Retrolisthesis of the inferoposterior C5 vertebral body.

b. Transfer preparation

Complete spinal immobilisation.
Insert an indwelling urinary catheter.
Send x-ray images electronically or on disc.
Provide antiemetic therapy.
Provide analgesia.
Secure the airway only if clinically required, such as inability to maintain immobilisation.
Discuss steroids with the receiving centre.
Coordinate with the destination to minimise bed transfers.
Keep the patient warm.

c. Steroids

Pro: a possible minor motor benefit in selected partial injuries if given early.
Con: insufficient evidence to recommend routine use and use is not universally accepted.
Con: complications include infection and gastrointestinal bleeding.

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