Assessing and Clearing the Cervical Spine Case 3

You are on duty in the ED one evening when the fire brigade declare a major incident.

There has been an explosion in a new nightclub and you are assigned to the resuscitation room.

A 22-year-old man is brought in to the department. He is conscious and talking in short sentences. He tells you that he was standing very close to the stage when something under the stage appeared to explode.

He was thrown backwards by an estimated 20 feet, landing heavily on his side. He has trouble hearing your questions but appears fully orientated…

You perform your primary survey:

A: The patient is talking to you with three-point cervical spine control in place and he is receiving high-flow oxygen via a reservoir bag.

B: His oxygen saturations are 96% and the respiratory rate is 22 breaths per minute (bpm). His chest is quiet throughout and you cannot hear any added sounds. There is no external evidence of injury to the thorax.

C: He is warm and well-perfused with a blood pressure of 110/86. His abdomen is soft but minimally tender around the umbilicus. Bowel sounds are present. There is no evidence of long-bone fracture.

D: He is GCS 15/15 with equal and reactive pupils and on log-roll has no external evidence of injury to the occiput, no step or deformity to the spine and a normal PR examination.

E: There are multiple wounds to the limbs, none of which appear to be bleeding profusely.

What should you do next?

Which factor in her presentation mandates further imaging using the Canadian Cervical Spine Rules?

What abnormality is showing in the x-ray?

Click on the x-ray to enlarge.