Clinical Case Database / Category: Practical Procedure

A traumatic C-Spine injury with extensive head wound

Publication details

Dr Louise Olson, Mr Sumohan Chatterjee
Foundation Years Journal, volume 6, issue 7, p.32 (123Doc Education, London, July 2012)

Abstract

Patients with traumatic head injuries can be daunting to manage, especially in the middle of the night. It is imperative to approach the patient as per Advanced Trauma Life Support (ATLS) guidance and get senior assistance early. Closure of scalp wounds requires adequate time, appropriate analgesia, consent and knowledge of the difference techniques for wound closure and complications that can develop. I present a case of a 75 year old female who attended A&E in the middle of the night after a mechanical fall with an unstable, c-spine injury and a deep laceration to her scalp of unknown size or depth. I present the step – by – step process of this lady’s scalp wound closure with the issues raised, followed by MCQs.

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Authors

Dr Louise Olson

-

Mr Sumohan Chatterjee (Corresponding author)

Salford Royal Foundation Trust
lolson@doctors.org.uk

References

1. Inline immobilisation of c-spine. http://www.laerdal.com/images/w200h200/
AEJBHVQJ.jpg (accessed 3 January 2012)
2. Normal lateral cervical spine x-ray illustrating vertebrae. http://www.jbjs.org/
data/Journals/JBJS/4361/e132fig1.jpg (accessed 1 May 2012)
3. Kool D R, Blickman J G. Advanced Trauma Life Support. ABCDE from a radiological
point of view. Emerg Radiol 2007 July; 14(3): 135–141. http://www.ncbi.nlm.nih.
gov/pmc/articles/PMC1914302/ (accessed 1 May 2012)
4. Trauma.org. The Lateral Cervical Spine X-Ray. http://www.trauma.org/archive/
spine/lateral-cspine.html (accessed 1 May 2012)
5. Lidocaine ampoules. http://www.google.co.uk/imgres?imgurl=http://www.
fireflymedical.co.uk/scripts/thumbnail.aspx?img=../ProdImages/
P0029.jpg&w=200&h=200&imgrefurl=http://www.fireflymedical.
co.uk/scripts/prodview.asp?idproduct=853&usg=__6JbREQUU l6kulxpaT
zWoYcBNzwc=&h=200&w=200&sz=31&hl=en&start=25&zoom=1&tbnid=yXaBzX
n7cyFDYM:&tbnh=104&tbnw=104&ei=mwTlTvyLIZL74QSMwMi5BQ&prev=/ima
ges?q=lidocaine ampoule&start=21&hl=en&safe%3
Dactive&sa=N&gbv=2&tbm=isch&itbs=1 (accessed 3 January
2012)
6. Photograph of a sutured head wound. http://www.sciencephoto.com/
image/279158/350wm/M5900095-Scalp_suturing_during_baldness_
reduction_surgery-SPL.jpg (accessed 3 January 2012)
7. The Multi media Procedure Manual. Local anaesthesia techniques. http://
emprocedures.com/anesthesia/pharmacology.htm (accessed 3 January 2012)
8. Paediatric Nursing. Calculation Skills. Accessed from: http://www.cardiff.ac.uk/
mathssupport/learningresources/mathsforhealth/pncalculationskills.pdf
(accessed 1 May 2012)
9. Trauma.org. Anaesthesia and Critical Care. Injuries to the cervical spine. http://
trauma.org/archive/anaesthesia/cspineanaes.html (accessed 1 May 2012)
10. Medical Criteria.com. Medical Research Council (MRC) Scale for Muscle Strength.
http://medicalcriteria.com/site/index.php?option=com_content&view=article
&id=238:neuromrc&catid=64:neurology&Itemid=80⟨=en (accessed
3 January 2012)
11. eMedicine Health. Removing Stitches. http://www.emedicinehealth.com/
removing_stitches/article_em.htm (accessed 3 January 2012)
12. The College of Emergency Medicine. Exclusion of significant cervical spine injury
in alert, adult patients with potential blunt neck trauma in the Emergency Department.
2010
13. Wheeless’ Textbook of Orthopaedics. Cervical Spine Clearance in the Trauma Patient.
http://www.wheelessonline.com/ortho/12588 (accessed 3 January 2012)
14. National Institute for Health and Clinical Excellence. CG56. Head injury: Triage,
assessment, investigation and early management of head injury in infants, children and
adults. London: 2003.

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