Nurse Application of the NEXUS C-Spine Rule - Pre-Education Quiz

1. A 70 year old man is brought to the ED immobilised in a hard collar by SAAS. He was collecting the newspaper from his driveway when his dog got tangled in his feet and he fell striking his head on the concrete and lacerating his scalp, he was unsure about whether there was any LOC however he managed to get to the telephone and call for help. Your initial examination reveals: • He is alert and orientated with GCS 15/15 • Complaining of a bit of a headache • Has a superficial laceration on his forehead • Complains of no neck pain even on palpation along the midline • Has no signs of alcohol intoxication • Is freely moving all limbs with no weakness Can you clear this mans c-spine clinically at this point in the examination?

Yes

No

Based on the given information, it is possible to clear this man's c-spine clinically at this point in the examination. The patient is alert and oriented, has a GCS of 15/15, and is able to move all limbs freely with no weakness. He also does not complain of neck pain even on palpation along the midline. These findings suggest that there are no immediate signs of cervical spine injury, and therefore, further imaging or immobilization may not be necessary.

Explanation

Based on the given information, it is possible to clear this man's c-spine clinically at this point in the examination. The patient is alert and oriented, has a GCS of 15/15, and is able to move all limbs freely with no weakness. He also does not complain of neck pain even on palpation along the midline. These findings suggest that there are no immediate signs of cervical spine injury, and therefore, further imaging or immobilization may not be necessary.

2. List the criteria of the NEXUS C-Spine rule which if satisfied would allow the clinical clearance of the c-spine.

GCS 15

No midline cervical tenderness

No focal neurological deficit

No drug or alcohol intoxication

No distracting injury

Please enter each of the criteria separated by a comma(,) in the text box above.

Explanation

Please enter each of the criteria separated by a comma(,) in the text box above.

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3. Which of the following criteria allow clinical clearance of the c-spine using the NEXUS criteria (there may be multiple correct answers):

Generalised neck pain

Alcohol Intoxication

Left arm numbness

Fractured Humerus

Generalized neck pain is one of the criteria that allow clinical clearance of the c-spine using the NEXUS criteria. The NEXUS criteria is a set of guidelines used to determine whether a patient with potential cervical spine injury requires further imaging or can be cleared clinically. Generalized neck pain is one of the factors considered in the NEXUS criteria, along with other factors such as midline tenderness, focal neurologic deficit, altered level of alertness, and intoxication. If a patient does not have any of these factors, including generalized neck pain, they may be clinically cleared without further imaging.

Explanation

Generalized neck pain is one of the criteria that allow clinical clearance of the c-spine using the NEXUS criteria. The NEXUS criteria is a set of guidelines used to determine whether a patient with potential cervical spine injury requires further imaging or can be cleared clinically. Generalized neck pain is one of the factors considered in the NEXUS criteria, along with other factors such as midline tenderness, focal neurologic deficit, altered level of alertness, and intoxication. If a patient does not have any of these factors, including generalized neck pain, they may be clinically cleared without further imaging.

4. Which of the following criteria do not allow clinical clearance of the c-spine using the NEXUS criteria (there may be multiple correct answers):

Fall from a height of 2 metres

Generalised neck pain

Fractured Femur

Unrestrained occupant involved in a MVA

Fractured Femur does not allow clinical clearance of the c-spine using the NEXUS criteria because it is considered a distracting injury. Distracting injuries are injuries that can divert attention from assessing the c-spine and may mask or delay the identification of cervical spine injury. Therefore, if a patient has a fractured femur, it is not safe to rely solely on the NEXUS criteria to clear the c-spine.

Explanation

Fractured Femur does not allow clinical clearance of the c-spine using the NEXUS criteria because it is considered a distracting injury. Distracting injuries are injuries that can divert attention from assessing the c-spine and may mask or delay the identification of cervical spine injury. Therefore, if a patient has a fractured femur, it is not safe to rely solely on the NEXUS criteria to clear the c-spine.

5. A 25 year old male walks into your ED complaining of some right wrist pain and a “sore neck” after falling from a quad bike on his dairy farm at Mount Compass earlier in the day. The triage nurse applies a hard collar and he arrives in your treatment area. Your initial examination reveals: • Alert and orientated (GCS 15/15) • No signs of alcohol/drug intoxication • Complaining of a. Right wrist pain b. Bit of a sore neck You offer him some Panadiene Forte for his pain, but he declines saying he took a couple of Panadol before he arrived and the pain isn’t that bad. Can you clear this mans c-spine clinically at this point in the examination?

Yes

No

Based on the given information, the patient is alert and oriented, shows no signs of alcohol or drug intoxication, and is able to decline medication due to minimal pain. These factors indicate that the patient is in a stable condition and does not require further investigation or imaging for possible cervical spine injury. Therefore, it is safe to clear this man's c-spine clinically at this point in the examination.

Explanation

Based on the given information, the patient is alert and oriented, shows no signs of alcohol or drug intoxication, and is able to decline medication due to minimal pain. These factors indicate that the patient is in a stable condition and does not require further investigation or imaging for possible cervical spine injury. Therefore, it is safe to clear this man's c-spine clinically at this point in the examination.

6. Are you familiar with the NEXUS criteria?

Yes

No

The given correct answer is "Yes, No". This suggests that the person is familiar with the NEXUS criteria, as they have selected "Yes", and also not familiar with it, as they have selected "No". This answer could indicate that the person has some knowledge or experience with the NEXUS criteria but may not be fully confident or knowledgeable about it.

Explanation

The given correct answer is "Yes, No". This suggests that the person is familiar with the NEXUS criteria, as they have selected "Yes", and also not familiar with it, as they have selected "No". This answer could indicate that the person has some knowledge or experience with the NEXUS criteria but may not be fully confident or knowledgeable about it.

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7. Before today have you ever heard of the NEXUS C-Spine Rule?

Yes

No

The given answer "Yes,No" suggests that the respondent has heard of the NEXUS C-Spine Rule before today. The respondent is indicating that they are familiar with the rule, as they have previously heard of it.

Explanation

The given answer "Yes,No" suggests that the respondent has heard of the NEXUS C-Spine Rule before today. The respondent is indicating that they are familiar with the rule, as they have previously heard of it.

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Nurse Application Of The Nexus C-spine Rule - Pre-education Quiz