High energy transfer mechanism associated with:

• Displaced mid-face fracture (LeForte II or III)

• Basilar skull fracture with carotid canal involvement

• Closed head injury consistent with diffuse axonal injury and GCS < 6

• Cervical vertebral body or transverse foramen fracture, subluxation, or ligamentous injury at any level

• Any fracture at C1-C2

• Near hanging with anoxia

• Clothesline type injury or seat belt abrasion with significant swelling, pain or altered mental status