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The NEXUS criteria was developed by Hoffman and colleagues in 1998 and is validated for use in the ED. Return visit for reassessment of same injury Known vertebral disease (ankylosing spondilitis, rheumatoid arthritis, spinal stenosis, previous spinal surgery) (Diagram has been re-designed by the team for clarity – click on the diagram to link to a higher-resolution version of the picture) It uses 3 primary factors to determine whether a given patient needs imaging: 1) Is there any high-risk factor that mandates radiography? 2) Is there any low-risk factor that allows safe assessment of range of motion? 3) Can the patient actively rotate his or her neck 45° right and left? (See Figure 1) Strict exclusion criteria eliminate some of the ED population. Since then, the CCR has been validated for use in the emergency department, at triage, and by paramedics in the field. The CCR was developed by Stiell and colleagues in 2001. The Canadian C-Spine Rule (CCR) and the National Emergency X-Radiography Utilization Study Low-Risk Criteria (NEXUS criteria) are clinical decision tools developed to help us decide when blunt trauma patients require C-spine X-ray. NEXUS) should you use to asses this patient? The Analysis: Which clinical decision rule (Canadian C-spine vs. She is now on a stretcher in your emergency department. She did complain of midline C-spine tenderness as a result, she was boarded and collared prior to transport. On examination by paramedics, the young woman denied paraesthesias. She was wearing a seatbelt and her airbags did not deploy. His one great achievement is being the father of three amazing children.A 32-year-old female was the driver in a simple rear-end motor vehicle collision at about 40km/h. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of , the RAGE podcast, the Resuscitology course, and the SMACC conference. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.Īfter finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. > High risk injury or neurological deficit -> MRIĬhris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. (4) Formal radiologist + Orthopaedic/Neurosurgical expert opinion (3) CT c-spine (high resolution, 1mm slices with sagittal reconstructions) 3 view xrays + CT (high resolution, 1.5-2mm slices with sagittal reconstructions) misses mechanism of injury.lateral c-spine, AP, PEG, swimmers (oblique views) still misses 10% and may displace injuries!.lateral c-spine, AP and PEG misses 10% of injuries (25-50% of studies being inadequate).lateral c-spine only misses 15% of injuries.c-spine xrays + CT + an awake patient who can be examined based on ATLS guidelines.Removal of hard collar desirable for a number of reasons: until cleared patients must be immobilized (hard collar, in-line stabilisation, log rolling).in the patient with TBI clinical clearance is not an option.can be cleared clinically and/or radiologically.5-10% of severe TBI have an associated unstable cervical fracture. 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