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Thu, 25 Jul 2002 23:07:30 -0400

Well you hit on a very important issue, overworked staff and  not enough
help, I guess we can no longer deliver state of the art care on a shoe
string budget.

Salim El-Hayek MD FACS
----- Original Message -----
From: "Will Owens" <owenswb@hotmail.com>
To: <trauma-list@trauma.org>
Sent: Thursday, July 25, 2002 12:37 AM
Subject: spinal immobilization

> Here's another question about cervical spine clearance, and one I've been
> hard-pressed to answer using textbooks, etc--as an Emergency Physician, I
> encounter (surprise!) intoxicated patients on a daily basis.  Many come to
> the ED in full spinal immobilization after falling, getting hit on the
head,
> etc.  I order our standard C-spine series (AP, lateral, open-mouth), which
> is read by either me or the radiologist as normal.  The problem is, the
> patient is so intoxicated that he cannot cooperate with a clinical exam,
and
> has self-anesthetized himself to the point that he can't tell me what
hurts
> and what doesn't.  I've removed him from the board and kept the collar on.
> NOW--what constitutes appropriate spinal immobilization until he's sober
> enough for me to examine him?  Should I restrain him with tape across the
> forehead, a sheet tied around the chest, and four-point restraints?
> Chemical restraints are difficult, as they may confuse future
examinations,
> and even with a healthy dose of Ativan/Haldol, patients tend not to lie
> supine.  Our nursing staff is overworked enough without having to
supervise
> these patients constantly to make sure the collar remains on the neck,
> rather than on the floor, face, etc.  Any opinions?  Or better yet, any
> evidence?  Thanks to the great minds on the list!
>
> Will Owens, MD
>
>
>
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spinal immobilization