What are the red flags for neck sprain & whiplash in urgent care?

Paraesthesia or weakness in the limbs → Cord or nerve injury — immobilise, imaging, ED; Midline bony tenderness after significant mechanism → Imaging per C-spine rule; Age 65+ or dangerous mechanism → High-risk — imaging; Neck pain with headache, neuro signs or after manipulation → Vertebral artery dissection

Which decision rule is used for neck sprain & whiplash?

Canadian C-spine rule: HIGH RISK → image: age ≥ 65, dangerous mechanism, or paraesthesia in the limbs; LOW RISK factor present? simple rear-end collision, sitting in clinic, walking at any time, delayed-onset neck pain, or no midline tenderness; If low-risk factor present → can they actively rotate 45° left and right?; Able to rotate → no imaging needed. Applies to alert (GCS 15), stable adults. If any high-risk factor, or no low-risk factor, or unable to rotate → CT cervical spine per NICE NG232.

What should I prescribe for neck sprain & whiplash?

Paracetamol: 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) (As needed); Ibuprofen: 400 mg three times a day with food (3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy)

Whiplash & Neck Injury (Canadian C-spine Rule) | Urgent Care Clinic

Q: What safety-netting advice should I give for neck sprain & whiplash?

Advise the patient to return or seek help if: Numbness, tingling or weakness in the arms or legs; Severe headache, problems with vision, speech or balance; Pain becoming much worse rather than better.

1Rule out first — red flags

If you find…	…then
Paraesthesia or weakness in the limbs	Cord or nerve injury — immobilise, imaging, ED
Midline bony tenderness after significant mechanism	Imaging per C-spine rule
Age 65+ or dangerous mechanism	High-risk — imaging
Neck pain with headache, neuro signs or after manipulation	Vertebral artery dissection

2Focused history

Mechanism: speed, rear-end vs other, rollover, ejection, fall from height
Onset of neck pain: immediate or delayed
Tingling, weakness, numbness in arms/legs
Headache, dizziness, visual change
Age, osteoporosis, ankylosing spondylitis / rheumatoid

3Focused examination

Midline tenderness (spinous processes)
Paraspinal tenderness
Active rotation 45° left and right (only if rule allows)
Upper and lower limb neurology

4Decide — investigate only if it changes the plan

Canadian C-spine rule

HIGH RISK → image: age ≥ 65, dangerous mechanism, or paraesthesia in the limbs
LOW RISK factor present? simple rear-end collision, sitting in clinic, walking at any time, delayed-onset neck pain, or no midline tenderness
If low-risk factor present → can they actively rotate 45° left and right?
Able to rotate → no imaging needed

Applies to alert (GCS 15), stable adults. If any high-risk factor, or no low-risk factor, or unable to rotate → CT cervical spine per NICE NG232.

Investigation	Only if…
CT cervical spine	Only if the Canadian C-spine rule indicates imaging

5Treat & send home

Management & advice

Keep the neck moving; avoid soft collars
Regular analgesia for a few days, heat
Most improve within weeks; some ache for longer
Driving: only when able to turn the head fully to check blind spots

Refer / follow-up

Not improving after 6 weeks → GP / physiotherapy

℞

Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.

Drug	Dose	Duration / notes
Paracetamol	1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk)	As needed
Ibuprofen	400 mg three times a day with food	3–5 days. Avoid: NSAID-sensitive asthma, GI bleed/ulcer, renal impairment, anticoagulants, heart failure, pregnancy

6Safety-net

Say it like this

Your neck has been strained, like a sprain, but there’s no sign of a bone injury using the national rule we follow. Keep it moving gently, use the painkillers regularly for a few days, and it should settle over the next few weeks. Come back straight away if you get numbness or weakness in your arms or legs, or a severe headache.

Come back / call 111 — or 999 if severe — if:

Numbness, tingling or weakness in the arms or legs
Severe headache, problems with vision, speech or balance
Pain becoming much worse rather than better

7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Whiplashnhs.uk/conditions/whiplash

Neck painnhs.uk/conditions/neck-pain

8Document

Neck sprain & whiplash — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — NECK SPRAIN & WHIPLASH PRESENTING COMPLAINT: HISTORY Mechanism: speed, rear-end vs other, rollover, ejection, fall from height: Onset of neck pain: immediate or delayed: Tingling, weakness, numbness in arms/legs: Headache, dizziness, visual change: Age, osteoporosis, ankylosing spondylitis / rheumatoid: RED FLAGS (record present / absent) [ ] Paraesthesia or weakness in the limbs [ ] Midline bony tenderness after significant mechanism [ ] Age 65+ or dangerous mechanism [ ] Neck pain with headache, neuro signs or after manipulation PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Midline tenderness (spinous processes): Paraspinal tenderness: Active rotation 45° left and right (only if rule allows): Upper and lower limb neurology: DECISION RULE — Canadian C-spine rule: result ______ INVESTIGATIONS: none required / CT cervical spine — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Whiplash, Neck pain Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Numbness, tingling or weakness in the arms or legs - Severe headache, problems with vision, speech or balance - Pain becoming much worse rather than better Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:

✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.

More injuries & musculoskeletal

Ankle & foot injuryTwisted ankle or foot — Ottawa rules decide the X-ray.Knee injuryTwisting or direct knee injury — Ottawa knee rule, spot the ACL and locked knee.Wrist injury & scaphoidFall on the outstretched hand — distal radius vs scaphoid.Hand & finger injuryBoxer’s fracture, mallet finger, crush injuries and the hand you must not miss.