A 30 year old Thai worker was involved in Road Traffic Accident along Jalan Telanai which involved 3 other vehicle. He was unrestrained driver and was under the influence of alcohol. When the paramedics arrived on the scene, it took 20 minutes to free the patient from the vehicle.
Upon arrival to the A&E at RIPAS he was agitated and confused. His BP was 80/40 and pulse 120. He had deep laceration on the occiput, bruising around the flank and an open fracture dislocation of the ankle. There was some movement of both his upper limbs, but he was not moving his lower limbs.
After primary survey was done the trauma panel x-rays revealed this x-ray.Question:
1. Give two abnormality on this x-ray?
2. How does it correlate with the clinical findings?
3. After stabilizing his vitals, what would be your next investigation of choice?
3 comments:
Patient appears to have prevertebral soft tissue swelling at the level of C1 through C3 and there is disruption of the normal anatomical relationship of the odontoid process to the anterior protion of C1. Spinal cord compression secondary to this finding would explain the clinical findings of lower extremity paralysis or paresis.
Well done David, that's absolutely right. This patient actually was about to have a CT Scan when he suddenly deteriorated and had cardiac arrest in the CT room. A laparotomy later night revealed diffuse retro and intraperitoneal bleed.
The patient later died in ICU most probably as a result of DIC.
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