Traumatic Torticollis

[chet]

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Maybe a dumb question, but do you guys image these? Difference in peds versus adults? Seems like guidelines are split as they could be cleared by Nexus but not by the Canadians. Thoughts?

 

[shoal]

image... trauma plus torticolis must consider fracture

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[goodoldalky]

CT adults or older children, if a young child plain film and benzo and if improved stop there if not then MRI if your suspicion is high enough... Because of the incidence of SCIWORA and ligamentous injuries being more common in kids who are too young to get a reliable exam, CT is not optimal and probably useless radiation

 

[gman33]

CT adults or older children, if a young child plain film and benzo and if improved stop there if not then MRI if your suspicion is high enough... Because of the incidence of SCIWORA and ligamentous injuries being more common in kids who are too young to get a reliable exam, CT is not optimal and probably useless radiation

What do you use for sedation to get the Mri in young kids?

 

[goodoldalky]

What do you use for sedation to get the Mri in young kids?

I call CRNA/anesthesia to do it. This requires monitoring etc and there's no way for me to do that while on shift. For my procedural sedation in kids I will almost always use ketamine. Versed if it's minor.

 

[deleted109597]

Yeah, if I'm concerned about SCIWORA (which requires at least some neuro deficit beyond "pain in the neck"), they're getting admitted, and that service can arrange all the finer bits of MRI. I don't have the ability to leave the department for an hour to go sedate some kid in the scanner. Sedation team is only present from 8-5 anyway, and they don't take call.

 

[gman33]

I was wondering about the management variability. I work at a trauma center and by that point in the workup, I'd have the patient admitted to either trauma or peds.
No chance I'd have time to sedate a kid for an mri.

Anyone work somewhere that they would have to do that?

In those cases a transfer somewhere else keeping the kid in a collar would probably be appropriate.

 

[Old_Mil]

Maybe a dumb question, but do you guys image these? Difference in peds versus adults? Seems like guidelines are split as they could be cleared by Nexus but not by the Canadians. Thoughts?

There is no way I am letting a traumatic torticollis out of my ED without a CT.

And if the CT is negative will probably look at admitting for an MRI.