2. STANDARD: CERVICAL SPINE X-RAYS FOR ACUTE TRAUMA PATIENTS
Clinical studies and medical literature reveal x-rays are not immediately required on patients presenting with some acute injuries or illness. The following x-rays are not routinely indicated in patients with a reliable history and physical exam:
A. Criteria for not obtaining cervical spine x-rays.
(1) No complaint of cervical spine pain;
(2) No localized cervical spine tenderness by palpation;
(3) No subjective or objective findings of spinal cord or nerve root injury;
(a) Subjective: Weakness or paresthesia
(b) Objective: Motor or sensory deficit; and,
(4) No other significant painful injuries.
(5) Have a reliable exam history and physical exam and appropriate response (i.e., appropriate response from patient).
B. Obtaining cervical spine x-rays
(1) When c-spine x-rays are deemed necessary, adequate lateral films, which demonstrate all seven cervical vertebrae, should be obtained with the patient's neck immobilized. A swimmer's view may be required to see all seven cervical vertebrae.
(2) After clearing the lateral view, AP and odontoid views may be obtained. Immobilization should be continued if clinically indicated.
(3) If plain films are unsatisfactory, or are negative but the clinical suspicion of a c-spine injury remains, additional films and/or CT scan may be indicated.
C. Discharge Instructions: When the emergency medical provider determines that a patient may be discharged, written instructions must be documented on the Emergency Department Medical Record and signed by the patient. The instructions should include all of the following, as appropriate:
(1) Specific advice regarding recommended treatment and/or medications relating to the patient's clinical problem;
(2) Information about follow-up, if needed, which includes the name of an appropriate physician and/or clinic and a suggested time period in which the patient should be seen; and,
(3) Instructions to call or return to the Emergency Department if symptoms progress or if the patient encounters difficulty in implementing the suggested follow-up plans.
