A patient involved in a motor vehicle accident presents with neck pain and increased paresthesia into the hands and feet upon neck flexion. What should be the next step in management?

A patient involved in a motor vehicle accident presents with neck pain and increased paresthesia into the hands and feet upon neck flexion. What should be the next step in management?

• A. Apply a cervical collar
• B. Refer to the emergency room
• C. Order imaging studies
• D. Perform cervical manipulation

Answer: (B)

In this scenario, the patient’s symptoms suggest the possibility of a serious cervical spine injury or cord compression, especially given the increased paresthesia in the hands and feet upon neck flexion. The presence of neck pain combined with neurological symptoms such as paresthesia raises concern for conditions like cervical radiculopathy or myelopathy, both of which could indicate instability or trauma to the spinal cord. The recommended next step in management is to refer the patient to the emergency room. This is critical for several reasons. First, an emergency room can provide immediate access to advanced imaging studies (such as CT or MRI) and skilled neurologic evaluation to assess for potential life-threatening conditions. Second, timely referral can prevent further injury. For instance, if a fracture or dislocation is present, any movement could exacerbate the injury, increasing the risk of long-term neurological deficits. The other options, such as applying a cervical collar, ordering imaging studies, or performing cervical manipulation, may not adequately address the pressing need for acute evaluation and treatment in a potentially unstable situation. Applying a collar can be part of immobilization but does not provide the necessary immediate diagnostic or therapeutic interventions. Ordering imaging studies is essential but would typically occur after an emergency evaluation. Performing cervical manipulation could

In this scenario, the patient’s symptoms suggest the possibility of a serious cervical spine injury or cord compression, especially given the increased paresthesia in the hands and feet upon neck flexion. The presence of neck pain combined with neurological symptoms such as paresthesia raises concern for conditions like cervical radiculopathy or myelopathy, both of which could indicate instability or trauma to the spinal cord.

The recommended next step in management is to refer the patient to the emergency room. This is critical for several reasons. First, an emergency room can provide immediate access to advanced imaging studies (such as CT or MRI) and skilled neurologic evaluation to assess for potential life-threatening conditions. Second, timely referral can prevent further injury. For instance, if a fracture or dislocation is present, any movement could exacerbate the injury, increasing the risk of long-term neurological deficits.

The other options, such as applying a cervical collar, ordering imaging studies, or performing cervical manipulation, may not adequately address the pressing need for acute evaluation and treatment in a potentially unstable situation. Applying a collar can be part of immobilization but does not provide the necessary immediate diagnostic or therapeutic interventions. Ordering imaging studies is essential but would typically occur after an emergency evaluation. Performing cervical manipulation could