4. Physical Examination
• Primary survey:
• A : patent airway, can talk, tender along spinous process of
c- spine, neck limit ROM due to Pain
• B: trachea in midline , clear breath sound, equal both lungs, chest
compression test negative , oxygen sat 87%
• C: HR 88/min BP 169/70 mmHg no external bleeding
• D:E4V5M6 pupil, 3 mm RTLBE , no lateralization
• E:not tender along TLS spine
6. Physical Examination
• HEENT : no pale conjunctiva , anicteric sclera , on Hard collar
• CVS: normal s1s2 no murmur
• Lungs: Clear breath sound , equal both lungs , no adventitious
sound
• Abdomen : no abdominal distension, soft , not tender ,
normoactive bowel sound
• Extremities : no deformity
7. Physical Examination
• Neurology:
• good consciousness, not cooperative
• E4V5M6
• pupil 3 mm RTLBE
• motor Grade V all
• Sensory Intact
• DTR : 2+ all
• PR : normal sphincter tone
• Others can not evaluate
14. Cervical Spine Injury
• -have History of accident
• -Neck tenderness , Muscle contract ,tenderness
and swelling
• -***can not elevate head from supine position
15. Cervical Spine Injury
• Imaging ( Nexus criteria and Canadian C
spine Rule)
• -> on hard collar first
• -> Film C spine AP , Lateral cross table , open
mouth , +- oblique view
• -> CT scan bone
• -> MRI suspected cord injury
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muhemwh
16. Cervical Spine Injury
• Upper Cervical Spine Injury
skull base – C2
• Sub-axial Cervical spine injuries
C3-c7
→ rotation fn.
as flew 1ohm A.
17. Traumatic spondylolisthesis of Axis
( Hangman’s Fracture)
• Introduction:
• -> Bilateral Fracture of pars interarticularis
• ->Mechanism : Hyperextension fracture of pars
Secondary flexion Tears PLL and disc
allowing subluxation
Presentation:
-Symptom : neck pain
-Physical examination : usually neurologically intact
20. Traumatic spondylolisthesis of Axis
( Hangman’s Fracture)
• Displaced vs Nondisplaced
• Displaced
-stepping more than 3 mm
-treatment :
reduction with skull traction 6weeks-- > SOMI brace 6weeks
If fail reduction from skull traction-> operation for reduction
and fusion C1 C3
• Non Displaced fracture
-stepping less than 3 mm , displacementC2 and C 3
-stable type
- Treatment : SOMI Brace