Case Discussion

[Dimoak]

I figured it has been a while since there was a case discussion on this forum, so for entertainment and maybe educational sake, I decided to toss one out.


31yo M presents to ED trauma bay with C-Spine injuries from ATV accident in a highly wooded area. EMS estimates 1.5 hours injury to ED time. Labored breathing identified at ED, pt receives immobilization and intubated (hemodynamically stable). T2 demonstrates spinous process fractures in C4 and C5, C4-5 facet dislocation, PLL compromise at C5-6. Would you give this pt solumedrol or take them straight to OR?

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[mpp]

If the CT confirms bilateral facet disclocation and the only fractures are in the spinous process, the patient needs to be reduced with traction and put in a halo. You need a good exam first so I'd wake him up. If you can't get a good exam than he can go the OR for open reduction. If the facets are not truly dislocated/jumped and just distracted, then he needs to go to the OR and traction would be contraindicated.

If the patient does not have other injuries I'd start the solumedrol just for medicolegal reasons, less so than for any chance that it will help in recovery.