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I completed my medical school and background EM training from India (Christian Medical College, Vellore and Apollo Hospitals, Hyderabad) where I worked for 4 years. Following this, I devoted (with all my heart) about 1.5 years to do US Medical Licensing Exams. My stint towards an EM Residency in States did not work but it took me to places and it has been quite a journey. I then relocated to London, England to work as a Registrar (Non-Trainee) in A&E. This gave me an opportunity to better understand NHS, EM training pathways and more importantly the EM Mindsets in the United Kingdom. 

Currently, I am pursuing Higher Specialist Training in Emergency Medicine at South East Scotland Deanery where I have the honour and privilege of training under some of the most innovative brains in the field of Emergency Medicine. Over the past few years, I have realised that LEARNING and UNLEARNING (which can be challenging!) is equally important to deliver cutting edge care to our patients.And through this blog, I aspire to disseminate knowledge, assist trainees with exams and stay up to date with contemporary EM literature. I have always been an avid FOAMed supporter because FOAMed has always played an indispensable role during my training. 

Lakshay Chanana
ST4 EM Trainee 
Edinburgh, Scotland

Monday, January 30, 2017

AP View and Common C-Spine injuries - Part 3

Long AP view checklist
While interpreting the AP view of C-Spine, address these two questions:

1. Are all the spinous processes in a straight line? (Red and Blue vertical lines)
If not, consider a rotational injury.

2. Look for approximately equal height of each vertebra and also spaces between adjacent spinous processes? (Light green arrows and small blue X marks)

Common Fractures 
Most C-spine injuries are managed with immobilisation or surgical repair. Indications for surgical intervention are:

  1. Neurological Deficits
  2. Severe Pain
  3. Unstable Spine

Jefferson's fracture (burst # of atlas due to axial loading)
X-Ray display outward displacement of lateral masses on open-mouth view. It is treated with hallo immobilisation/ surgical repair. 

Hangman's fracture: Fracture of both pedicles of C2 that occurs due to hyperextension of neck. It is treated with halo immobilisation/ surgery. 

Odontoid (Peg) Fractures
Type 1 - Philadelphia collar
Type 2 - Halo vest/ Surgical Repair
Type 3 - Halo vest

Vertical Compression fracture (Treated with traction/immobilisation)

Unilateral facet dislocation: On a lateral view, the involved vertebral body will be displaced <50% of its width. On anterior view, there is rotation of the involved vertebra, with the affected spinous process pointing toward the side that is dislocated. 

Bilateral facet dislocation: The vertebral body is dislocated anteriorly at least 50% of its width. These injuries usually present with neurologic deficits. 

Clay Shoveler's fracture i.e. Avulsion off the end of one of the lower cervical spinous processes, classically describes with C7. Rx with a soft collar. 

Images taken from:

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