Challenge of the Week / Pediatrics / 07.23.2021

A 3-year-old boy is struck by a car moving at high speed and presents to the emergency department with neck pain. If there is suspicion that he has sustained an atlanto-occipital dislocation, which of the following methods is preferred to immobilize his neck?
    • Apply the smallest adult-sized C-spine collar available
    • The preferred immobilization is sandbags/blocks around the head to immobilize the neck. An adult C-spine collar would likely distract the neck, worsening a presumed atlanto-occipital dislocation.
    • Apply gentle manual traction along the axis of the C-spine
    • The preferred immobilization is sandbags/blocks around the head to immobilize the neck. Applying in-line traction would distract the neck, worsening a presumed atlanto-occipital dislocation.
    • Place the child on an adult spine board
    • The preferred immobilization is sandbags/blocks around the head to immobilize the neck. An adult spine board will often cause neck flexion since the child’s head is relatively larger compared with the child’s body.
    • Apply sandbags/blocks to sides of head and tape them in place
    • The preferred immobilization is sandbags/blocks around the head to immobilize the neck, with a cutout in the transport board to prevent excessive neck flexion for a child.

     

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