MDM - Cervical Muscle Strain (Whiplash Injury) - Motor Vehicle Collision

[##]-year-old [male/female] with neck pain following a motor vehicle collision (MVC) with history and exam consistent with likely cervical muscle strain (whiplash injury).

Initial consideration in this patient included cervical spine fracture or dislocation, soft tissue injury to the chest, neck or torso, and cervical muscle strain among others.

Patient arrived to the ED following a [low/moderate] risk MVC [in cervical spine immobilization/and was placed in a cervical collar in triage/without indication for cervical spine immobilization in the field].  Cervical spine [could not be] cleared by [NEXUS criteria/Canadian C-Spine Rule] upon arrival in the ED.  Patient was noted to have a normal neurologic exam in the ED.  [CT/Plain films were obtained in the ED with no evidence of significant injury as noted above.]  Patient noted to have [right-/left-sided/bilateral] paraspinal muscle tenderness [with/without] associated muscle spasm.  Patient noted to have [no] evidence of contusions to the chest consistent with seatbelt injury.  No other significant tenderness or injury noted on exam with no indications for further imaging at this time.

Patient reported significant improvement with [treatment] prior to discharge from the ED.  We discussed return precautions, treatment [with analgesics/NSAIDs], and follow up with primary care doctor within one week for further evaluation, and the patient demonstrated understanding and agreement with this plan.

https://www.mdcalc.com/canadian-c-spine-rule
https://www.mdcalc.com/nexus-criteria-c-spine-imaging

Discharge Instructions - Cervical Strain (Whiplash)

As discussed in the Emergency Department prior to discharge, you have been diagnosed with cervical (neck) strain sometimes referred to as a ‘whiplash’ injury.

A whiplash injury happens when the small muscles in your neck tear, often after your head suddenly jerks forward and back.  This usually happens in the case of a sudden deceleration (slowing down) of a car, when your neck muscles are tensed and your head moves forward rapidly.

The treatment for whiplash is a cold compress (e.g. ice or a bag of frozen peas wrapped in a thin towel) and pain medication.  Apply ice for about 5-10 minutes at a time, then allow the skin to return to normal temperature before applying the ice again (this prevents frostbite).

In addition, it may be helpful to take an anti-inflammatory over-the-counter pain medication such as Ibuprofen (which is the same thing as Advil or Motrin) or Naproxen (same thing as Aleve).  If you are over age 70 or have kidney problems, check with your doctor before taking these medications.  The pain is usually worst on day two or three, after which it usually improves gradually.

If you have been prescribed a stronger pain medication like Hydrocodone (also known as Norco) or Oxycodone (also known as Percocet), only use it if your pain is not controlled by anti-inflammatory medications.  You may also have been prescribed a muscle relaxant such as Diazepam (also known as Valium) or Cyclobenzaprine (also known as Flexeril).  If you are taking one of these strong medications, DO NOT DRIVE OR OPERATE HEAVY MACHINERY WITHIN 8 HOURS OF TAKING THEM, as these medications can make you sleepy.  Norco and Percocet usually also cause constipation, so take an over-the-counter medicine for constipation, such as Metamucil or Docusate, at the same time as taking these medications.

You should feel better in 1-2 weeks.  If not, follow up with your family doctor to try other therapies like physiotherapy.

Return to the Emergency Department for new weakness or numbness in one or both arms, fever (≥38.0 °C or 100.4 °F), changes in your vision, slurred speech, worsening headache, or any new or concerning symptoms.