a 47-year-old man presents as a trauma activation after a head-on motor vehicle crash at 20 mph. he was a restrained driver and the airbags did deploy. there were no drugs or alcohol involved. he is uncertain if he lost consciousness. ems extricated him, put him in spinal immobilization, and splinted an obviously fractured femur. on primary survey, his airway is protected, he is breathing easily, is normotensive and has a glasgow coma scale score of 15. vital signs are within normal limits. the secondary survey is notable for a mildly tender right trapezius muscle and an ecchymotic and deformed left femur with normal distal neurovascular function. the presence of which historical or physical finding necessitates cervical spinal imaging per national emergency x-radiography utilization study (nexus) criteria?
