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Case Study #2: MVC
Transcript of Case Study #2: MVC
Ivana and her husband are on the way back from the airport after renewing their wedding vows in the "McMarriage Wedding Chapel" in Las Vegas then honeymooning in Mexico. You are working an evening shift. Ivana was wearing her seatbelt and is uninjured. However, her husband, a 33 year old male, was not restrained and is brought into the ED by EMS.
(diagnosed 2 weeks ago)
No surgical history
No traumatic history
"The Case of the Irresistible Force vs. the Immovable Object"
Liver Function Tests
Total Bili: 1.1
Urine Tox: neg
Segmented neutrophils: 82%
Band forms: 1
Red Blood Cells:
White Blood Cells:
Cervical spine fracture
Cervical spine subluxation
Cervical spine strain
Herniated cervical disc
q6 hours (or so)
Reversal of anticoagulation
Surgical evacuation if deteriorating
Not needed in this case...
Normal heart, no cardiomegaly, no infiltrates, pneumothorax, or free air.
Left anterior rib fractures of 7th and 8th ribs
Abnormal positioning of some of the facet joints due to distraction but no dislocation
Additional fracture of the body of C4
The vertical orientation of the fractures of the bodies of C4 and C5 indicate that there was severe axial loading.
(In fact these vertebral bodies kind of 'exploded' with propulsion of a bone fragment anteriorly (teardrop) and the larger part posteriorly against the spinal cord.)
Spinal surgery consultation
Closed reduction under fluoroscopy
Halo vest immobilization
Possible surgical immobilization
Flexion teardrop fracture of C5
Oriented to person, place time
Arrives walking normally, rubbing his neck
: EOMI, PERRLA, sclera non-icteric
Ecchymoses to midline, anterior forehead, No deformity to calvarium
Pharynx and nares are normal
: tender in midline posteriorly over C4-C6
Tender over bilateral trapezium muscles, no deformity. Range of Motion (?)
: No deformity, normal excursion, no ecchymoses, tender to
: irregular rhythm, S1S2 without gallop, rub, or murmur
: soft, NT, no ecchymoses or abrasions, normal BS
: no deformities or tenderness or ecchymoses, Pulses 2+ throughout bilaterally
: nontender in midline and to paraspinous muscles
: No facial asymmetry, CN 2-12 intact
Motor and sensory intact throughout, non-focal exam
Your patient was not wearing his seat belt when his car was hit from behind 30 minutes ago. He says he was stopped at a red light when this happened. He doesn't really remember the collision, and the first thing he can recall afterward is waking up with a sore neck while the paramedics were knocking on the window. He quickly regained consciousness and unlocked the door. The neck pain is described as sharp. He has no prior neck problems or any other injury, nor does he have any chest pain, shortness of breath, abdominal pain, or problems with his extremities.
Not necessary in this case...
However, a FAST exam may be indicated...
Fracture of the body of C5 with a small fragment anteriorly
Fracture of the spinous processus of C4
Acute angulation at the level of C5C6 with displacement of C5 in posterior direction
This is known as a _______ ________ fracture
Scalp contusion/soft tissue
1 PPD smoker for 12 years
Has 4 alcoholic drinks per week
Denies any non-prescription drug use
Sexually active with girlfriend. Monogamous for 5 years. Uses condoms...usually
Job: Aeronautical engineer
Father with HTN, CAD, MI at age 44
Mother: NIDDM, Gout
Temp: 37.0 C (98.6 F)
BP: 160/90 mmHg
HR: 110/min, irregular
O2 Sat: 97% on RA