Clinical Case Database / Category: Practical Procedure
Patient suffered a traumatic C-spine injury with extensive head wound
Dr Louise Olson, Mr Sumohan Chatterjee
Foundation Years Journal, volume 6, issue 7, p.40 (123Doc Education, London, July 2012)
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.
Access the Clinical Cases Database
A subscription is required to read the full article. Please subscribe using one of the options below.
|Foundation Years Clinical Cases Database||£29.00||6 months|
|Foundation Years Clinical Cases Database||£39.00||12 months|
Dr Louise Olson (Corresponding author)
Salford Royal Foundation Trust
Mr Sumohan Chatterjee
Salford Royal Foundation Trust
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=/images?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&lang=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.
Conflict Of Interest
The Journal requires that authors disclose any potential conflict of interest that they may have. This is clearly stated in the Journal’s published “Guidelines for Authors”. The Journal follows the Guidelines against Conflict of Interest published in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals (http://www.icmje.org/urm_full.pdf).
The authors of this article have not been paid. The Journal is financed by subscriptions and advertising. The Journal does not receive money from any other sources. The decision to accept or refuse this article for publication was free from financial considerations and was solely the responsibility of the Editorial Panel and Editor-in-Chief.
Patient Consent statement
All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts (http://www.icmje.org/urm_full.pdf). The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.
Animal & Human Rights
When reporting experiments on human subjects, the Journal requires authors to indicate whether the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the HelsinkiDeclaration of 1975, as revised in 2008.
About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.