Abstract
Altered mental status in the setting of polytrauma poses a challenge to the emergency team managing the patient. The tendency to miss positive findings in these circumstances increases several folds due to multiple factors such as depressed mental status/intoxication, presence of distracting injuries and concurrent life-threatening injuries that require more urgent attention. In view of this, NEXUS (National Emergency X-Radiography Utilization Study) criteria of clearing the cervical spine was adopted and used worldwide. Consensus on clearance of the other parts of spine is still lacking. This case reports highlights the findings in a 18-yrs-old male who presented with altered mental status, facial pain and abrasion, following a motor vehicle accident. Facial bone fracture was diagnosed and he was discharged. Three days later, he came with severe epigastric pain. Tenderness on palpation was noted at the spine and Computed Tomography (CT) scan was done. Multiple thoracic vertebra fractures were seen. As a conclusion, thorough primary and secondary survey should be done in patients who have regained full consciousness prior to discharge in order to avoid overlooking other serious injuries.
Keywords :
altered,
CT scan,
fracture,
mental status,
thoracic vertebra,
Abstrak
Keadaan status mental yang rendah di dalam politrauma merupakan cabaran kepada pasukan kecemasan dalam pengurusan pesakit. Kecenderungan untuk terlepas penemuan positif dalam keadaan ini meningkat beberapa kali ganda kerana pelbagai faktor seperti kemurungan/kemabukan, kehadiran kecederaan yang mengganggu dan kecederaan yang mengancam nyawa serentak, menyebabkan perlunya memberi perhatian yang lebih mendesak. Memandangkan keadaan ini, kriteria NEXUS (Kajian Penggunaan X-Radiografi Kecemasan Nasional) untuk memeriksa tulang belakang servikal telah diterima pakai dan digunakan di seluruh dunia. Walau bagaimanapun, tiada kata sepakat untuk memeriksa bahagian lain tulang belakang. Kes ini melaporkan seorang lelaki berusia 18 tahun dengan status mental berubah, sakit dan luka di bahagian muka akibat kemalangan jalan raya. Kepatahan di bahagian muka disahkan dan dia dibernarkan keluar dari hospital. Tiga hari kemudian dia kembali dengan sakit epigastrik yang teruk. Sakit pada bahagian belakang mendorong imbasan CT dilakukan. Beberapa vertebra toraks didapati patah. Sebagai kesimpulan, pemeriksaan primer dan sekunder yang menyeluruh perlu dilakukan pada pesakit yang telah sedar semula sebelum dibenarkan pulang.
Kata Kunci :
imbasan CT,
kepatahan,
Status mental berubah,
vertebra toraks,
Correspondance Address
Nik Azlan Nik Muhamad, Urology Unit, Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +603-91455703 Fax: +603-91456577 E-mail: nikazlanmuhamad@hotmail.com
