Editing Paediatric trauma (section)

== Spinal trauma ==
In children:
<nowiki>https://www.rch.org.au/clinicalguide/guideline_index/Cervical_spine_assessment/</nowiki>

* C-spine injuries are uncommon, but if known/suspected, they should be managed at RCH
* If age<8, they should be on a Thoracic Elevation Device to prevent flexion (as their head is too big to lie flat)
* If hard to maintain C-spine precautions because of anxiety or other issues, use in-line C-spine immobilisation
* C-spine immobilisation is required in the following:
** GCS<13
** Neck pain/midline tenderness/limitation of movement
** Using hands to support neck
** Any neurological deficit
** Significant head/facial/upper torso injuries
** Traumatic torticollis
** Substance affected with suspicious mechanism
** Any conditions known to predispose to C-spine injury
* Assessment
** Abnormal neurology - talk to NROS immediately
** Must be conscious, co-operative, unaffected by substances
** Ask about neck pain, weakness, paralysis or paraesthesiae
** Palpate midline, and lateral to midline
** If no midline tenderness or neurology, assess movement 45 degrees each way, then remove collar if they can do it without pain or developing neurological symptoms
** If they DO have any symptoms or signs, get cervical spine X-Rays
*** 5 or under - AP and lateral only
*** 6 or older - AP, lateral and odontoid
*** Lateral should include occiput to T1
** If x-rays are normal and symptoms resolved, C-spine can be cleared
** If abnormal X-rays, obviously needs discussion
** '''Normal x-rays:'''
*** '''Patients with ongoing neck symptoms'''
**** '''2 piece collar'''
**** '''Discuss with appropriate surgical team/ED consultant'''
*** Ambulant, otherwise well patients with midline tenderness +/- decreased ROM:
**** Two piece collar
**** Discharged home for r/v in ortho fracture clinic 1-2 weeks
**** Give handout off RCH website <nowiki>https://www.rch.org.au/kidsinfo/fact_sheets/Hard_collar_Aspen_collar/</nowiki>
*** Patients with significant other injuries and midline tenderness/decreased ROM
**** 2 piece collar
**** Cervical spine cannot be cleared
**** Probably going to need MRI
*** Obtunded/intubated multi-trauma patient
**** 2 piece collar
**** MRI when safe
**** If MRI normal, cease cervical spine precautions
** Normal CT does not exclude injury in the unconscious patient - can't be cleared, might need MRI

[[Category:Paed Surg]]