Master the Mayhem: 2025 ATLS Practice Exam – Be the Trauma Hero!

The National Emergency X-Radiography Utilization Study (NEXUS) criteria are designed to help clinicians determine whether a patient with potential cervical spine injury requires imaging to rule out an injury. One of the key elements of the NEXUS criteria is to identify certain characteristics that would preclude a safe clearance of the cervical spine.

The presence of altered level of consciousness, midline tenderness, or intoxication above a certain threshold are all significant factors that increase the risk of cervical spine injury. Specifically, impaired mental status due to intoxication could lead to confusion about the patient's symptoms and heightens the need for cautious evaluation. When a patient is intoxicated at a level above 20/hour, there is a chance they may not accurately report symptoms or physical sensations, which is critical in assessing c-spine injuries.

In contrast, if a patient has normal neurologic findings, it suggests that there is no significant spinal cord involvement or underlying injury that would warrant further imaging. This aspect can therefore support the clearance of the cervical spine, provided that the other NEXUS criteria are met and there are no other points of concern.

Hence, when interpreting the NEXUS criteria, the inability to clear the cervical spine due to intoxication aligns with the increased risk