Clinical Clearance of the Cervical Spine
Date: 30.05.1997 15:21 GMT
Is it safe
to clear C-spine injury nonradiographically ?
Date: 30.05.1997 06:22 GMT
is! read our article in J Trauma 1996;40:383-389
Date: 30.05.1997 09:46 GMT
if it was safe to clear C-spine basically without an x-ray.
Depends I think on the situation and location - If you are in
a city, and the x-ray is available within 30 or so minutes,
sure is simple to wrap the pt up and not take a chance - legally....
a wilderness aspect, yes, I think you can clear the c-spine
depending on the circumstances of how the pt was injured and
if it would help in the overall situation (delayed transport
- hours into days before getting to a hospital); rough terrain
prevents the easy removal of the patient (cave) - but the patient
is first - don't clear the c-spine just to make ur job in getting
them to the hospital easier.
Wilderness EMS Institute) has some information on clearing the
c-spine in the field. Their web is: www.wemsi.on.ca/
|| From: T. Adirim &
Date: 30.05.1997 16:09 GMT
It is not
safe to clear a C-spine INJURY non-radiographically.:)
there are times you can clear the C-spine (that is not injured)
by clinical exam in an awake alert (non-multiple trauma) patient
without a "distracting" injury. I suppose different hospitals
have different protocols based on the literature.
is to get c-spine x-rays in (awake) patients with a "significant"
mechanism of injury, neck pain or tenderness, who have sustained
a more than mild head injury, any neurologic deficit, or who
are not developmentally able to cooperate for an exam (an infant
or young child). Obviously all less than alert trauma patients
get C-spine series.
Date: 31.05.1997 02:36 GMT
due respect Dr. Palmer, to imply that nonradiologic clearance
of c-spine is malpractice is absurd! Just because a patient
arrives with a c-collar on doesn't mean films must be taken.
Clinical judgement will allow the vast majority of patients
to be cleared. I follow these guidelines.
1. No significant
2. No altered mental status or intoxication
3. No complaint of neck pain or neurologic symptoms
4. No distracting injury which could mask neck pain
conditions are met the collar is opened and the neck palpated.
No pain?.. the patient is asked to move through range of motion.
No complaint?...No Xrays.
Director, EMS Education & Trauma Care
Sacred Heart Hospital
Eau Claire, WI
Date: 31.05.1997 04:23 GMT
can you clear a C-Spine non-radiographically...... There was
a paper at last year's AAST meeting by Drs Zabel, Tinkoff, Wittenborn,
Ballard and Fulda from the Medical Center of Delaware in Wilmington
that tried to address your question. They assessed the value
of the lateral C-spine in alert, high risk blunt trauma patients.
They concluded, after 353 patients, that physical examination
alone more accurate and had a lower predictive probability rate
than the lateral C-spine.......
you can... in this narrow group of patients.... but most of
the auto accident victims I deal with are usually drunk or otherwise
altered.... Our approach is to do 3-5 views of the neck, and
clear it only if the physical exam is completely clear.. and
this is usually the next day.
King/Drew Medical Center
|| From: Charles Krin
Date: 01.06.1997 22:01 GMT
agree with Terry- the cavat here is "no distracting injury"-
had a 4 wheeler wreck several years ago- 45 yo wf with dislocated
Right shoulder, no other injuries found even on close inspection,
no pain to palpation, no significant bruising noted- reduced
the shoulder, and lo and behold, the neck starts hurting in
the C6 region- radiographically found a small chip fracture
of the lateral process on the right....most embarassing, as
I had to fess up to the chief of the ED about it....
S. Krin, DO FAAFP
02.06.97 04:32 GMT
to clarify the point that it is possible to clear the spine
without xray I'll let you know that I did it this very day,
and do it fairly regularly, as do all prehospital care providers.
Whenever you come on a wreck and don't immediately spine everybody
involved you (as a prehospital care provider) have, whether
you know it or not, gone through the 4 point check list previously
mentioned. Of course the mechanism is minor and the patients
are all ambulatory so it's easy to let them go. It's when the
mechanism is greater and the patient has spine being held when
you arrive that this skill becomes challenging.
had a police officer involved in a serious MVA. The occupant
of the other car was a trauma system entry, the cop was on the
ground being protected and told not to move. After a quick secondary,
and very consciously moving through a similar checklist I deferred
the need to take spinal precautions. These guidelines, coupled
with a strong intuition are very accurate in the hands of skilled
Gail Waldby MD
Date: 02.06.1997 18:30 GMT
had a very low volume trauma experience (residency 1977-1982
at U KS Kansas City and rural private practice) so definitely
have only anecdotal experience to share.
2 of my
most memorable C-spine injuries were
1. Patient with minor injuries, awake alert, no real complaints
(minimal if any neck pain) I was an intern and ordered a C-spine
films and got called by the Radiologist to come immediately
to X-ray since he had an unstable C-spine fracture (at this
time physicians were not allowed in the KU X-ray dept, in fact,
Paul O'Boynick, MD, Neurosurgery was arrested by our campus
cops when he refused as a senior resident to leave a patient
with a C-spine fracture unattended in X-ray---needless to say
Paul eventually got his way, but it was highly unusual to be
asked to come to X-ray to help with a patient
year lady in her 70's in van-car accident, got out of van, got
lawn chair out of back of van and was found by paramedics sitting
in lawnchair in front lawn of house that she had crashed near.
an unstable C-2 fracture plus flail chest.
this lady was going to get C-spine X-rays because of major other
survived neurologically intact.
Huron Clinic SD
Dr. Robert Marvin
Date: 04.06.1997 09:32 GMT
injuries (distracting to the patient)in the awake, alert, non-intoxicated
patient do not preclude clinically clearing the C-spine. I think
that these injuries are actually "distracting" to only the physician.
Disciplined review of systems and physical exam will keep the
physician out of trouble. Check out the LAC-USC study I believe
has already been referenced. Hopefully, one day we can stop
wasting so much time and resources on this one anatomic area.