Carolinas Core Concepts Core Concepts in EM; a repository for Carolinas lecture summaries.


M&M 11/17/11

Mike Koehler, MD

Peds C1/2 subluxation:

  • Patients <9yoa get different injuries and cannot be reliably cleared by NEXUS criteria. CT scans of the C-spine have not been shown to be better than plain films in identifying pediatric C-spine inuries.
  • The prevertebral space should measure <6mm (or <1/2 of a vertebral body) at C3 in pediatric patients. Also, the atlantodens interval should be <5mm in pediatric patients.


  • Remember that you must have a low Gestalt to apply the PERC rule.
  • EKG findings suggestive of PE include tachycardia and signs of pulmonary hypertension – the EKG shows right axis deviation, RBBB, T-wave inversions in V1-3, and a large S in lead I, Q-wave in II, and inverted T-wave in III (“S1Q3T3”). See below:


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