1. Cervical spine injuries Assessment and early management

2. A Dismal Image Cord injury not treatable still Unpredictable outcome Prolonged course of treatment Psychosocial factors Commonest and most devastating injury of axial skeleton

3. Spinal cord injuries Constitute 2-5 % OF all blunt trauma 40-50 cases / million 40 % of cervical spine injuries have cord involvement Cost factor

4. Initial management steps Haemodynamic stabilization Cervical collar X-ray CT scan MRI Steroids

5. Traction Secondary exam ICU admission Prevention of DVT Physiotherapy Initial management steps

6. Eratic practice Variations Cross table xray Unconcious pt high resolution imaging cost and morbidity

7. Guide lines British trauma society working party

8. immobilization Critera for risk Teqnique Spine boards Log rolling Transfer slides

9. Special circumstances Neck not neutral Unco-operative pt Vomiting Intubation Transfer to another hospital

10. Exclusion criteria clinical Alertness Head injury No alcohol or drugs No neck pain No neurology No distracting injury

11. Plain xrays Ap Lateral open mouth Oblique Other views

12. Ct scan Targeted 2-3 mm Whole multi slice ct

13. Mri scan Ligaments,disc and neural tissue In unconciuos pts

14. Dynamic studies Flexion and extension xrays Or fluroscopy

15. Unconcious In line immobilization Mri Dynamic Ct

16. Aalgorithm