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https://www.readbyqxmd.com/read/28922275/indications-for-ct-angiography-of-the-vertebral-arteries-after-trauma
#1
Joseph P Drain, Douglas S Weinberg, James S Ramey, Timothy A Moore, Heather A Vallier
STUDY DESIGN: Retrospective. OBJECTIVE: The purpose of this project is to identify factors that predict vertebral artery injury (VAI) in an effort to assess risks and benefits of computed tomography angiography (CT-A) of the neck in the trauma setting. We seek to develop guidelines for practitioners to stratify patients at medium/high risk of VAI from those who are at low risk. SUMMARY OF BACKGROUND DATA: VAI and blunt carotid injury (BCI) together comprise blunt cerebrovascular injury (BCVI)...
September 15, 2017: Spine
https://www.readbyqxmd.com/read/28921727/hot-off-the-press-embedded-clinical-decision-support-in-electronic-health-record-decreases-use-of-high-cost-imaging-in-the-emergency-department-embed-study
#2
Corey Heitz, Justin Morgenstern, William K Milne
This longitudinal before/after study of embedded CDRs assessed the effects of clinical decision support on use of common imaging studies. Among high users, rates of CT-brain and CT c-spine were reduced after implementation of embedded clinical decision instruments, while in low users, rates increased. This article summarizes the manuscript and the Skeptics Guide to Emergency Medicine podcast, as well as the ensuing social media/online discussion. This article is protected by copyright. All rights reserved.
September 15, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28844294/cervical-spine-collar-removal-by-emergency-room-nurses-a-quality-improvement-project
#3
Guillaume Fontaine, Massimo Forgione, Francis Lusignan, Marc-André Lanoue, Simon Drouin
INTRODUCTION: The Canadian C-Spine Rule (CCR) is a clinical decision aid to facilitate the safe removal of cervical collars in the alert, orientated, low-risk adult trauma patient. Few health care settings have assessed initiatives to train charge nurses to use the CCR. This practice improvement project conducted in a secondary trauma center in Canada aimed to (1) train charge nurses of the emergency room to use the CCR, (2) monitor its use throughout the project period, and (3) compare the assessments of the charge nurses with those of emergency physicians...
August 22, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28752244/accuracy-of-3d-fluoro-navigated-anterior-transpedicular-screws-in-the-subaxial-cervical-spine-an-experimental-study-on-human-specimens
#4
Jan Bredow, C Meyer, F Siedek, W F Neiss, L Löhrer, L P Müller, P Eysel, G Stein
INTRODUCTION: Pedicle screw stabilization, the standard technique in the thoracic and lumbar spine, is increasingly used in the cervical spine. Initial studies on the use of anterior pedicle screws (ATPS) in the cervical spine have been recently published. ATPS use has theoretical advantages over posterior stabilization. We have already established a 3D-fluoroscopy navigation setup in a study of artificial bones. The aim of the current study was to evaluate the positioning quality/accuracy of ATPS introduced to human specimens...
July 27, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28750969/a-case-study-utilizing-myofascial-release-acupressure-and-trigger-point-therapy-to-treat-bilateral-stringhalt-in-a-12%C3%A2-year-old-akhal-teke-horse
#5
Tammy Brockman
"Stringhalt" is a horse condition that causes one or both hind legs to spasm when walking, trotting or backing. The condition is thought to be related to a neurological cause from either plant toxicity or peripheral nerve injury. The prognosis is poor and the horse's performance and quality of life can be affected. Treatment has included surgically cutting the digital extensors with varied results. The objective of the study is to utilize soft tissue release via acupressure, trigger point and myofascial release to decrease symptoms of stringhalt...
July 2017: Journal of Bodywork and Movement Therapies
https://www.readbyqxmd.com/read/28728206/-subaxial-cervical-spine-injuries-treatment-recommendations-of-the-german-orthopedic-and-trauma-society
#6
Philipp Schleicher, Matti Scholz, Frank Kandziora, Andreas Badke, Florian Hans Brakopp, Helmut Klaus Friedrich Ekkerlein, Erol Gercek, Rene Hartensuer, Philipp Hartung, Jan-Sven Gilbert Jarvers, Philipp Kobbe, Stefan Matschke, Robert Morrison, Christian W Müller, Miguel Pishnamaz, Maximilian Reinhold, Klaus John Schnake, Gregor Schmeiser, Gregor Stein, Bernhard Ullrich, Thomas Weiß, Volker Zimmermann
In a consensus process during four sessions in 2016, the working group "lower cervical spine" of the German Society for Orthopedic and Trauma Surgery (DGOU), formulated "Therapeutic Recommendations for the Lower Cervical Spine", taking into consideration the current literature. Therapeutic goals are a permanently stable, painless cervical spine and the protection against secondary neurologic damage while retaining the greatest possible amount of motion and spinal profile. Due to its ease of use and its proven good reliability, the AOSpine classification for subaxial cervical injuries should be used...
July 20, 2017: Zeitschrift Für Orthopädie und Unfallchirurgie
https://www.readbyqxmd.com/read/28723840/cervical-spine-evaluation-and-clearance-in-the-intoxicated-patient-a-prospective-western-trauma-association-multi-institutional-trial-and-survey
#7
Matthew J Martin, Lisa D Bush, Kenji Inaba, Saskya Byerly, Martin Schreiber, Kimberly A Peck, Galinos Barmparas, Jay Menaker, Joshua P Hazelton, Raul Coimbra, Martin D Zielinski, Carlos V R Brown, Chad G Ball, Jill R Cherry-Bukowiec, Clay Cothren Burlew, Julie Dunn, C Todd Minshall, Matthew M Carrick, Gina M Berg, Demetrios Demetriades, William Long
INTRODUCTION: Intoxication often prevents clinical clearance of the cervical spine (Csp) after trauma leading to prolonged immobilization even with a normal CT scan. We evaluated the accuracy of CT at detecting clinically significant Csp injury, and surveyed participants on related opinions and practice. METHODS: A prospective multicenter study (2013-2015) at 17 centers. All adult blunt trauma patients underwent structured clinical examination and imaging including a Csp CT, with follow-up thru discharge...
July 19, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28684013/cervical-spine-alignment-in-helmeted-skiers-and-snowboarders-with-suspected-head-and-neck-injuries-comparison-of-lateral-c-spine-radiographs-before-and-after-helmet-removal-and-implications-for-ski-patrol-transport
#8
Jared Murray, David A Rust
OBJECTIVE: Current protocols for spine immobilization of the injured skier/snowboarder have not been scientifically validated. Observing changes in spine alignment during common rescue scenarios will help strengthen recommendations for rescue guidelines. METHODS: Twenty-eight healthy volunteers (18 men, 10 women) age 47±17 (range 20-73) (mean ±SD with range) underwent a mock rescue in which candidate patrollers completing an Outdoor Emergency Care course performed spine immobilization and back boarding in 3 scenarios: 1) Ski helmet on, no c-collar; 2) helmet on, with c-collar; and 3) helmet removed, with c-collar...
July 3, 2017: Wilderness & Environmental Medicine
https://www.readbyqxmd.com/read/28665242/changes-in-use-of-cervical-spine-magnetic-resonance-imaging-for-pediatric-patients-with-nonaccidental-trauma
#9
Ahyuda Oh, Michael Sawvel, David Heaner, Amina Bhatia, Andrew Reisner, R Shane Tubbs, Joshua J Chern
OBJECTIVE Past studies have suggested correlations between abusive head trauma and concurrent cervical spine (c-spine) injury. Accordingly, c-spine MRI (cMRI) has been increasingly used in radiographic assessments. This study aimed to determine trends in cMRI use and treatment, and outcomes related to c-spine injury in children with nonaccidental trauma (NAT). METHODS A total of 503 patients with NAT who were treated between 2009 and 2014 at a single pediatric health care system were identified from a prospectively maintained database...
June 30, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28656384/x-ray-vs-ct-in-identifying-significant-c-spine-injuries-in-the-pediatric-population
#10
Andrew T Hale, Abraham Alvarado, Amita K Bey, Sumit Pruthi, Gregory A Mencio, Christopher M Bonfield, Jeffrey E Martus, Robert P Naftel
PURPOSE: Evaluation of cervical spine injury (CSI) in children requires rapid, yet accurate assessment of damage. Given concerns of radiation exposure, expert consensus advises that computed tomography (CT) should be used sparingly. However, CT can provide superior image resolution and detection of pathology. Herein, we evaluate if X-ray offers equal diagnostic accuracy compared to CT imaging in identifying CSI in children. METHODS: We conducted a retrospective study between October 2000 and March 2012 of pediatric patients evaluated for cervical spine injury at a level 1 trauma center...
June 27, 2017: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28647656/delayed-retroclival-and-cervical-spinal-subdural-hematoma-complicated-by-preexisting-chiari-malformation-in-adult-trauma-patient
#11
Ha Son Nguyen, Hoon Choi, Shekar Kurpad, Hesham Soliman
INTRODUCTION: Traumatic spinal subdural hematoma involving the retroclival region and upper cervical spine is a rare pathology. To our knowledge, there have only been 2 prior cases in an adult trauma patient. We describe a patient with preexisting Chiari 1 malformation, who recently sustained a unilateral type 1 occipital condyle fracture with associated disruption of the tectorial membrane and transverse ligament, which returned with a retroclival subdural hematoma extending down to C7, causing spinal cord compression and symptomatic obstructive hydrocephalus...
September 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28607336/cervical-spine-motion-during-tracheal-intubation-with-king-visiontm-video-laryngoscopy-and-conventional-laryngoscopy-a-crossover-randomized-study
#12
Mohamed R El-Tahan, Samah El Kenany, Alaa M Khidr, Abdulmohsen A Al Ghamdi, Ahmed M Tawfik, Abdullah S Al Mulhim
BACKGROUND: The King VisonTM (KVL) videolaryngoscope with a wide field of view could potentially reduce cervical spine motion during intubation. We aimed to compare the extent of cervical spine movement during laryngoscopy using the KVL and Macintosh laryngoscopes. METHODS: Following ethical approval, 29 patients with a normal cervical spine requiring general anesthesia and tracheal intubation were randomly subjected to both KVL and Macintosh laryngoscopy in a crossover...
June 12, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28605800/fact-finders-for-patient-safety-routine-intravenous-access-for-epidural-steroid-injections-without-sedation
#13
Zachary L McCormick, Adrian Popescu, Clark C Smith
No abstract text is available yet for this article.
June 1, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28601333/variability-in-ct-imaging-of-blunt-trauma-among-ed-physicians-surgical-residents-and-trauma-surgeons
#14
Melissa K James, Shi-Wen Lee, Jennifer A Minneman, Maureen D Moore, Taylor R Klein, R Jonathan Robitsek, Phillip S Barie, Sebastian D Schubl
BACKGROUND: Trauma triage decisions can be influenced by both knowledge and experience. Consequently, there may be substantial variability in computed tomography (CT) scans desired by emergency medicine physicians, surgical chief residents, and attending trauma surgeons. We quantified this difference and studied the effects of each group's decisions on missed injuries, cost, and radiation exposure. METHODS: All blunt trauma activations at an urban level 1 trauma center were studied over a 6-mo period...
June 1, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28554588/pathologic-c-spine-fracture-with-low-risk-mechanism-and-normal-physical-exam
#15
Andrew Hunter, Jolion McGreevy, Judith Linden
Cervical spinal fracture is a rare, but potentially disabling complication of trauma to the neck. Clinicians often rely on clinical decision rules and guidelines to decide whether or not imaging is necessary when a patient presents with neck pain. Validated clinical guidelines include the Canadian C-Spine Rule and the Nexus criteria. Studies suggest that the risks of a pathologic fracture from a simple rear end collision are negligible. We present a case of an individual who presented to an emergency department (ED) after a low speed motor vehicle collision complaining of lateral neck pain and had multiple subsequent visits for the same complaint with negative exam findings...
May 23, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28435869/a-dynamic-hydrophobic-core-orchestrates-allostery-in-protein-kinases
#16
Jonggul Kim, Lalima G Ahuja, Fa-An Chao, Youlin Xia, Christopher L McClendon, Alexandr P Kornev, Susan S Taylor, Gianluigi Veglia
Eukaryotic protein kinases (EPKs) constitute a class of allosteric switches that mediate a myriad of signaling events. It has been postulated that EPKs' active and inactive states depend on the structural architecture of their hydrophobic cores, organized around two highly conserved spines: C-spine and R-spine. How the spines orchestrate the transition of the enzyme between catalytically uncommitted and committed states remains elusive. Using relaxation dispersion nuclear magnetic resonance spectroscopy, we found that the hydrophobic core of the catalytic subunit of protein kinase A, a prototypical and ubiquitous EPK, moves synchronously to poise the C subunit for catalysis in response to binding adenosine 5'-triphosphate...
April 2017: Science Advances
https://www.readbyqxmd.com/read/28426562/asymptomatic-cervical-spine-fractures-current-guidelines-can-fail-older-patients
#17
Christopher D Healey, Sarah K Spilman, Bradley D King, Joseph E Sherrill, Carlos A Pelaez
BACKGROUND: Older adults represent a growing proportion of trauma patients treated in the United States, and cervical spine (c-spine) fracture is an injury that is increasingly common in this population. Neck pain is a major component of current clinical clearance guidelines, but some older adults with c-spine fractures report no neck pain after injury. The objective of this study was to investigate the frequency at which c-spine fractures were unassociated with neck pain in an aging population...
July 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28411008/cone-beam-computed-tomography-incidental-findings-of-the-cervical-spine-and-clivus-retrospective-analysis-and-review-of-the-literature
#18
Noura A Alsufyani
OBJECTIVE: The aim of this study was to analyze and describe incidental findings in the cervical spine (C-spine) and the clivus encountered in cone beam computed tomography (CBCT) imaging. The wide range of possible anatomic variants and pathoses is discussed in the context of the medical and dental literature to clarify their radiographic appearance and clinical implications as a guide for the oral and maxillofacial radiologist. STUDY DESIGN: A retrospective analysis of radiographic reports was conducted based on CBCT images from 2 oral and maxillofacial imaging centers...
March 19, 2017: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
https://www.readbyqxmd.com/read/28391603/embedded-clinical-decision-support-in-electronic-health-record-decreases-use-of-high-cost-imaging-in-the-emergency-department-embed-study
#19
Kelly Bookman, David West, Adit Ginde, Jennifer Wiler, Robert McIntyre, Andrew Hammes, Nichole Carlson, David Steinbruner, Matthew Solley, Richard Zane
OBJECTIVE: The objective was to evaluate the impact of evidence-based clinical decision support tools integrated directly into provider workflow in the electronic health record on utilization of computed tomography (CT) brain, C-spine, and pulmonary embolism (PE). METHODS: Validated, well-accepted scoring tools for head injury, C-spine injury, and PE were embedded into the electronic health record in a manner minimally disruptive to provider workflow. This was a longitudinal, before/after study in five emergency departments (EDs) in a healthcare system with a common electronic health record...
July 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28256741/osteoporosis-is-the-most-important-risk-factor-for-odontoid-fractures-in-the-elderly
#20
Johannes Kaesmacher, Claudia Schweizer, Alexander Valentinitsch, Thomas Baum, Anna Rienmüller, Bernhard Meyer, Jan S Kirschke, Yu-Mi Ryang
Traumatic odontoid fractures (TOFs) have been described as the most common injury affecting the C-spine in the elderly. Previous studies have identified degenerative changes and bone loss as important predisposing factors. However, their interaction and respective age-adjusted impact needs further clarification. We conducted a retrospective analysis of 5303 patients (aged ≥60 years) admitted to a level I trauma center between January 2008 and January 2016 who underwent CT imaging of the C-spine. Ninety-two patients with TOF and 80 patients with other cervical spine fractures (OCSF) were identified and a respective 3:1 age- and sex-matched control group without fractures after trauma was built...
July 2017: Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research
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