SAQ 140 – Trauma – cervical spine columns and adult epiglottitis

Question 1. cervical spine columns and adult epiglottitis.

a. Anterior column

• Anterior longitudinal ligament.
• Anterior half of vertebral bodies and discs.

b. Middle column

• Posterior longitudinal ligament.
• Posterior half of vertebral bodies and discs.

c. Posterior column

• Facet joints.
• Pedicles.
• Laminae.
• Ligamentum flavum.
• Spinous process.
• Interspinous ligament.

d. Flexion / extension x-rays

• No role in the initial ED investigation.
• Risk of neurological injury if not performed correctly.
• No validated criteria for evaluating flexion / extension studies.
• False negatives may occur due to cervical muscle spasm.
• CT or MRI is more appropriate.

e. X-ray abnormalities

• Enlarged epiglottis / thumbprint sign.
• Enlarged retropharyngeal or pre-spinal soft tissue shadow.

f. Initial management

• IV antibiotics such as ceftriaxone.
• Sit upright.
• Prepare for advanced airway with senior anaesthetic support; RSI with direct / video laryngoscopy or gaseous induction in theatre if the situation permits.
• Adrenaline nebuliser as a temporising measure if airway compromised.
• Analgesia such as IV fentanyl or morphine.
• IV dexamethasone.