![]() ![]() The Denver criteria include “focal neurologic deficit, arterial hemorrhage, cervical bruit/thrill (<50 yo), infarct on head CT, expanding neck hematoma, neuro exam inconsistent with head CT, midface fractures, c-spine injuries, basilar skull fractures, GCS <8, hanging with anoxic brain injury, seat belt abrasion or other soft tissue injury of the anterior neck resulting in significant swelling or altered mental status. The development of focal neurologic findings may be delayed up to 10-72 hours, complicating diagnosis in the acute setting.Ĭurrently, the Eastern Association for the Surgery of Trauma (EAST) recommends that pediatric patients should be screened by adult criteria, called the Denver or Memphis criteria. Higher grade lesions may require intervention including endovascular stenting or ligation. Most BCVI are treated medically with aspirin or anticoagulation. BCVI may cause ischemia and other neurologic sequelae. ![]() Should this patient receive a CTA of the neck?īlunt cervical vascular injury (BCVI) has an incidence of 0.03-0.9% in pediatric blunt trauma. Bilateral lower strength at 5/5 at hip flexion, dorsi-/plantarflexion. Bilateral upper extremity strength 5/5 at deltoids, biceps, triceps, and handgrip. Neurologic: GCS: eyes 4, best verbal response 5, best motor response 6 TOTAL GCS SCORE: 15. Musculoskeletal: no palpable long bone deformities, no bony tenderness to palpation Pelvis: non-tender, stable to anterior-posterior/lateral compression ![]() Seatbelt sign across lower abdomen and L anterior thighīack: no tenderness to palpation in t-spine or l-spine. Seat belt sign across L anterior chestĪbdomen: soft, non-distended, normal bowel sounds, nonperitoneal with tenderness to palpation in RLQ. Respiratory: clear to auscultation bilaterallyĬardiovascular: regular rate and rhythm. Neck: trachea appears midline, there is a cervical collar in place. Head: normocephalic / atraumatic no hematoma, no abrasionsĮNT: tympanic membranes bilaterally clear Denies numbness/tingling.īP 116/47 | Pulse (!) 115 | Resp 19 | Wt 37.5 kg | SpO2 100%īREATHING: non-labored Breath sounds: Clear to auscultation bilaterallyĬIRCULATION: pulse palpable: Bilateral Radial, DP and PT pulses are normal and symmetricĬapillary refill: normal less than 2 seconds Patient states his pain is worst in his neck, rates pain 6/10. Per EMS, patient was found in police cruiser on arrival, patient states he walked at scene. Patient was the restrained front seat passenger in a head on collision. The patient is a 11 y.o. male with no past medical history who presents as trauma activation after MVC. ![]()
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