Spinal levels—T4 ER Quiz 2

You are the intern on call for neurosurgery at a major Northeast medical centre with a great college basketball team. Your chief resident is clipping an aneurysm. You receive a phone call from an outside hospital.

Outside Doc:

Hello. I have a motorcycle accident victim in my ER now. He is hemodynamically stable and is breathing fine on his own. His problem is that he can't move his legs.

I got a pin level on him, and he starts feeling pin at around two inches above his nipple line. I looked up this in my pocket brain, and it seems that the level where I first notice pinprick loss is where the T4 dermatome is. The first level that my pin exam reveals sensation is C4.

I have a C-spine Xray down to C5 which looks OK. I can't get a good look at his upper T spine.

He's really complaining about his cervical collar, and since his C-spine Xray is clear, I'd like to take it off and ship him to you for some tomograms or MR of his upper thoracic spine. OK?

Your response:

(By the way, the aneurysm just burst and your chief resident isn't available. Your senior resident just got called to a code in the unit. You are on your own, bubbie. Start thinking.)

(Sweating? Good. This is not a theoretical problem. Think it through and come up with your best answer. Write it down (yes, document your care plan, doctor...)

what your chief resident will tell you after the excitement is over.