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C1/C2 injury

McSwain, Norman E nmcswai at tulane.edu
Mon May 30 14:48:08 BST 2011


Additional comment
I would limit fluids and would not volume overload. This will make the brain edema worse. This is usually not a neurogenic hypotension with vascular dilation of the extremities
 
You might also consider carotid imaging to look for vascular damage
 
Norman
 
Norman McSwain, MD, FACS
Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

________________________________

From: trauma-list-bounces at trauma.org on behalf of McSwain, Norman E
Sent: Mon 5/30/2011 8:39 AM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: C1/C2 injury


The outcome of legal hanging with a long drop produces a fracture, dislocation, distraction injury. Short drops and suicide hangings usually result in asphyxia and ischemia from carotid compression or jugular intracranial vascular distension. Although the patient may have a c-spine problem, this should not be the major thrust of your resuscitative efforts. Attend to the brain first
 
Norman
 
Norman McSwain, MD, FACS
Trauma Director, Spirit of Charity Trauma Center, ILH/MCLNO
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

________________________________

From: trauma-list-bounces at trauma.org on behalf of Kenneth Mak
Sent: Mon 5/30/2011 8:04 AM
To: Trauma-List [TRAUMA.ORG]
Subject: C1/C2 injury



Appreciate advice regarding the management of this cervical injury:

25 year old female, found hanged and immediately brought down. Attended by
paramedics and noted to have PEA - CPR commenced and continued into hospital
ED, ultimately with return of spontaneous rhythm and circulation, but with
fixed and dilated pupils. Intubated but difficult to maintain inline neck
immobilisation due to torticollis.

Post-resuscitation able to maintain haemodynamic status with volume loading
alone. CT head shows diffuse cerebral oedema, CT cervical spine shows
rotatory subluxation of C1 on C2. No obvious fractures noted. Some scan
images enclosed.

Outlook is obviously poor but assuming she had a better outcome, how should
such cervical injuries be managed? I gather these injuries are seen more
commonly in the paediatric population and often in non-traumatic settings.
Is halo fixation still an option or should C1-C2 fixation be considered?


Kenneth Mak
Singapore


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