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Fri, 21 Jun 2002 13:03:36 -0400

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I once had a link to the State of Maine's Field Spinal clearance =
protocols.  Lost in the cyber world, I'm afraid.  Pret?  Help me out?

Regardless, I do not believe that they included Mechanism of Injury.  =
Many providers seem to forget that a vertebral fracture is a bone =
fracture, and broken bones HURT! =20

Best,

Jeff Brosius
Paramedic, etc.
Atlanta, GA
www.prehospital-perspective.com
medic245@mindspring.com
"The fate of the wounded rest=20
in the hands of the one that=20
applies the first dressing."
-- Nicholas Senn, 1896
  ----- Original Message -----=20
  From: John L. Meade=20
  To: trauma-list@trauma.org=20
  Sent: Friday, June 21, 2002 10:35 AM
  Subject: RE: Consider this Case Study

  Perhaps "field criteria" have been published that are different from =
the ED criteria for clinical clearance of cervical spines. The published =
ED criteria do not mention mechanism of injury as a criterion. There are =
5 criteria that must be met to clinically clear: no midline cervical =
tenderness, no focal neurologic deficit, normal alertness, no =
intoxication, and no painful, distracting injury.

  Hoffman JR. Mower WR. Wolfson AB. Todd KH. Zucker MI. Validity of a =
set of clinical criteria to rule out injury to the cervical spine in =
patients with blunt trauma. National Emergency X-Radiography Utilization =
Study Group. [see comments.] [erratum appears in N Engl J Med 2001 Feb =
8;344(6):464.]. [Journal Article. Multicenter Study] New England Journal =
of Medicine. 343(2):94-9, 2000 Jul 13.

  JM=20

   =20

  John L. Meade, MD, FACEP=20

  Emergency Medicine Specialist

  Emerald Healthcare Group, P.A.=20

  http://www.statdoc.com/ =20

  When you dream in color, it's a pigment of your imagination.

  -----Original Message-----
  From: trauma-list-admin@trauma.org =
[mailto:trauma-list-admin@trauma.org] On Behalf Of Krin135@aol.com
  Sent: Friday, June 21, 2002 08:59
  To: trauma-list@trauma.org
  Subject: Re: Consider this Case Study

  In a message dated 05-Jun-02 13:58:26 Central Daylight Time, =
dinerman@computron.net writes:

  Case in point regarding vascular Doppler in the field:

  On my last shift I attended a 34 y/o male bicyclist who, while on his =
customary pre-dawn ride,  hit a hard to see gate and fell on his =
extended right arm. He was rewarded with a severely angulated, fractured =
/ dislocated right elbow. (Probably snapped the humeral head off).  He =
was wearing his helmet tho.  (Said he bikes for his health!) =20

  Cleared C-spine according to our protocol, discovered no other notable =
injuries during the full exam,(some minor road rash / lacs) splinted the =
arm from shoulder to fingertips (no radial pulse was noted before or =
after splinting), moved him to the rig, started IV NS for analgesia, =
administered 4 mg Morphine for pain, obtained vascular Doppler of distal =
fingertips indicating circulation present, transported to local ED.  =
Local ED MD confirmed Doppler, and diagnosis via x-ray. Local ortho and =
vascular specialists were contacted and Pt was transferred from local ED =
to Houston (75 miles) for open reduction at a specialist ortho hospital. =
=20

  Catching up with the list after a long spell of not being able to read =
in detail...

  Just out of curiosity, how did you clear this patient's C spine =
clinically, since he had a significant distracting injury as well as a =
significant mechanism of injury? Any scuff marks on the helmet? IIRC, =
all of the current protocols specify that patients with both of those =
factors (mechanism and distracting injury) should *not* be cleared in =
the field.

  Got bit on that one a long time ago, with a gal who had a dislocated =
shoulder from a 4 wheeler wreck. Turned out that the pain in the =
shoulder was masking neck pain, and follow up films were suspicious for =
a posterior fracture.

  We weren't able to do CT at that hospital that weekend, so had to ship =
her off...I suspect that there was no significant sequelae, as she was =
lost to follow up, but it did get my pulse to rise for a bit.

  ck

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<BODY lang=3DEN-US vLink=3Dpurple link=3Dblue bgColor=3D#ffffff>
<DIV>I once had a link to the State of Maine's Field Spinal clearance=20
protocols.&nbsp; Lost in the cyber world, I'm afraid.&nbsp; Pret?&nbsp; =
Help me=20
out?</DIV>
<DIV>&nbsp;</DIV>
<DIV>Regardless, I do not believe that they included Mechanism of =
Injury.&nbsp;=20
Many providers seem to forget that a vertebral fracture is a bone =
fracture, and=20
broken bones HURT!&nbsp; </DIV>
<DIV><FONT face=3DArial size=3D2></FONT>&nbsp;</DIV>
<DIV>Best,</DIV>
<DIV>&nbsp;</DIV>
<DIV>Jeff Brosius<BR>Paramedic, etc.<BR>Atlanta, GA<BR><A=20
href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002-June/3D"http://www.prehospital-perspective.com">www.prehospital-perspecti=
ve.com</A><BR><A=20
href=3D"mailto:medic245@mindspring.com">medic245@mindspring.com</A><BR>"T=
he fate=20
of the wounded rest <BR>in the hands of the one that <BR>applies the =
first=20
dressing."<BR>-- Nicholas Senn, 1896</DIV>
<BLOCKQUOTE dir=3Dltr=20
style=3D"PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; =
BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
  <DIV style=3D"FONT: 10pt arial">----- Original Message ----- </DIV>
  <DIV=20
  style=3D"BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: =
black"><B>From:</B>=20
  <A title=3Djmeade@statdoc.com href=3D"mailto:jmeade@statdoc.com">John =
L. Meade</A>=20
  </DIV>
  <DIV style=3D"FONT: 10pt arial"><B>To:</B> <A =
title=3Dtrauma-list@trauma.org=20
  href=3D"mailto:trauma-list@trauma.org">trauma-list@trauma.org</A> =
</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Sent:</B> Friday, June 21, 2002 =
10:35=20
AM</DIV>
  <DIV style=3D"FONT: 10pt arial"><B>Subject:</B> RE: Consider this Case =

Study</DIV>
 <DIV> </DIV>
 <DIV class=3DSection1>
 Perhaps &#8220;field=20
 criteria&#8221; have been published that are different from the =
<FONT=20
 color=3Dblack>ED<SPAN=20
 style=3D"COLOR: black"> criteria for clinical clearance of cervical =
spines. The=20
 published <SPAN=20
 style=3D"COLOR: black">ED<SPAN=20
 style=3D"COLOR: black"> criteria do not mention mechanism of injury as =
a=20
 criterion. There are 5 criteria that must be met to clinically clear: =
no=20
 midline cervical tenderness, no focal neurologic deficit, normal =
alertness, no=20
 intoxication, and no painful, distracting injury.
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black">&nbsp;
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black">&nbsp;
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black">Hoffman<FONT=20
 color=3Dblack> JR. Mower WR. =
<FONT=20
 color=3Dblack>Wolfson<FONT=20
 color=3Dblack> <SPAN=20
 style=3D"COLOR: black">AB.<SPAN=20
 style=3D"COLOR: black"> <SPAN=20
 style=3D"COLOR: black">Todd<SPAN=20
 style=3D"COLOR: black"> <SPAN=20
 style=3D"COLOR: black">KH<SPAN=20
 style=3D"COLOR: black">. Zucker MI. Validity of a set of clinical =
criteria to=20
 rule out injury to the cervical spine in patients with blunt trauma. =
National=20
 Emergency X-Radiography Utilization Study Group. [see comments.] =
[erratum=20
 appears in N Engl J Med 2001 Feb 8;344(6):464.]. [Journal Article. =
Multicenter=20
 Study] New=20
 England =
Journal of=20
 Medicine. 343(2):94-9, 2000 Jul 13.
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black">&nbsp;
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black">&nbsp;
 <DIV>
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: Arial">JM=20

 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: Arial">&nbsp;=20
 
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: =
Arial">John<FONT=20
 face=3DArial color=3Dblack size=3D3><SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: Arial"> =
<FONT=20
 face=3DArial color=3Dblack size=3D3><SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: =
Arial">L.<FONT=20
 face=3DArial color=3Dblack size=3D3><SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: Arial"> =
<FONT=20
 face=3DArial color=3Dblack size=3D3><SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: =
Arial">Meade<FONT=20
 face=3DArial color=3Dblack size=3D3><SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: Arial">,=20
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: =
Arial">MD<FONT=20
 face=3DArial color=3Dblack size=3D3><SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: Arial">, FACEP=20
 
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-STYLE: italic; =
FONT-FAMILY: Arial">Emergency=20
 Medicine Specialist
 <SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: Arial">Emerald =
Healthcare=20
 Group, P.A. 
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: black"><A =
href=http://www.trauma.org/index.php/community/list/url/http:list.ftech.net/pipermail/trauma-list/2002-June/3D"http://www.statdoc.com/"><FONT=20
 face=3DArial color=3Dblack size=3D3><SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: =
Arial">http://www.statdoc.com/</A><FONT=20
 face=3DArial color=3Dblack size=3D3><SPAN=20
 style=3D"FONT-SIZE: 12pt; COLOR: black; FONT-FAMILY: Arial">&nbsp;=20
 
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: black">&nbsp;
 When you=20
 dream in color, it's a pigment of your=20
 imagination.<SPAN=20
 style=3D"COLOR: navy"> </DIV>
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: =
Tahoma">-----Original=20
 Message----- From:=20
 trauma-list-admin@trauma.org [mailto:trauma-list-admin@trauma.org] =
<SPAN=20
 style=3D"FONT-WEIGHT: bold">On Behalf Of =
Krin135@aol.com <SPAN=20
 style=3D"FONT-WEIGHT: bold">Sent: <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Tahoma">Friday, =
June 21,=20
 2002<SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: Tahoma">=20
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: =
Tahoma">08:59<FONT=20
 face=3DTahoma color=3Dblack size=3D2><SPAN=20
 style=3D"FONT-SIZE: 10pt; COLOR: black; FONT-FAMILY: =
Tahoma"> <SPAN=20
 style=3D"FONT-WEIGHT: bold">To: =
trauma-list@trauma.org <SPAN=20
 style=3D"FONT-WEIGHT: bold">Subject: Re: Consider this Case =

  Study</SPAN></FONT></P>
  <P class=3DMsoNormal style=3D"MARGIN-LEFT: 0.5in"><FONT face=3DArial =
color=3Dblack=20
  size=3D3><SPAN style=3D"FONT-SIZE: 12pt; COLOR: =
black"></SPAN></FONT>&nbsp;</P>
  <P class=3DMsoNormal style=3D"MARGIN-LEFT: 0.5in"><I><FONT =
face=3D"Arial Black"=20
  color=3Dblack size=3D2><SPAN=20
  style=3D"FONT-SIZE: 10pt; COLOR: black; FONT-STYLE: italic; =
FONT-FAMILY: 'Arial Black'">In=20
  a message dated </SPAN></FONT></I><I><FONT face=3D"Arial Black" =
color=3Dblack=20
  size=3D2><SPAN=20
  style=3D"FONT-SIZE: 10pt; COLOR: black; FONT-STYLE: italic; =
FONT-FAMILY: 'Arial Black'">05-Jun-02</SPAN></FONT></I><I><FONT=20
  face=3D"Arial Black" color=3Dblack size=3D2><SPAN=20
  style=3D"FONT-SIZE: 10pt; COLOR: black; FONT-STYLE: italic; =
FONT-FAMILY: 'Arial Black'">=20
  </SPAN></FONT></I><I><FONT face=3D"Arial Black" color=3Dblack =
size=3D2><SPAN=20
  style=3D"FONT-SIZE: 10pt; COLOR: black; FONT-STYLE: italic; =
FONT-FAMILY: 'Arial Black'">13:58:26</SPAN></FONT></I><I><FONT=20
  face=3D"Arial Black" color=3Dblack size=3D2><SPAN=20
  style=3D"FONT-SIZE: 10pt; COLOR: black; FONT-STYLE: italic; =
FONT-FAMILY: 'Arial Black'">=20
  Central Daylight Time, dinerman@computron.net=20
  writes:<BR><BR></SPAN></FONT></I></P>
  <P class=3DMsoNormal style=3D"MARGIN-LEFT: 0.5in"><FONT face=3DArial =
color=3Dblack=20
  size=3D2><SPAN=20
  style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: =
black"><BR></SPAN></FONT><FONT=20
  face=3D"Comic Sans MS" color=3Dblack size=3D2 FAMILY=3D"SCRIPT"><SPAN=20
  style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">Case=20
  in point regarding vascular </SPAN></FONT><FONT face=3D"Comic Sans MS" =

color=3Dblack size=3D2><SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">Doppler<FONT=20
 face=3D"Comic Sans MS" color=3Dblack size=3D2><SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">=20
 in the field: On my last shift I attended a 34 y/o male =
bicyclist who,=20
 while on his customary pre-dawn ride,&nbsp; hit a hard to see gate and =
fell on=20
 his extended right arm. He was rewarded with a severely angulated, =
fractured /=20
 dislocated right elbow. (Probably snapped the humeral head off).&nbsp; =
He was=20
 wearing his helmet tho.&nbsp; (Said he bikes for his health!)&nbsp;=20
 Cleared C-spine according to our protocol, discovered no other =
notable=20
 injuries during the full exam,(some minor road rash / lacs) splinted =
the arm=20
 from shoulder to fingertips (no radial pulse was noted before or after =

splinting), moved him to the rig, started IV NS for analgesia, =
administered 4=20
 mg Morphine for pain, obtained vascular Doppler of distal fingertips=20
 indicating circulation present, transported to local ED.&nbsp; Local=20
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">ED<FONT=20
 face=3D"Comic Sans MS" color=3Dblack size=3D2><SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">=20
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">MD<FONT=20
 face=3D"Comic Sans MS" color=3Dblack size=3D2><SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">=20
 confirmed <SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">Doppler<FONT=20
 face=3D"Comic Sans MS" color=3Dblack size=3D2><SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">,=20
 and diagnosis via x-ray. Local ortho and vascular specialists were =
contacted=20
 and Pt was transferred from local <SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">ED<FONT=20
 face=3D"Comic Sans MS" color=3Dblack size=3D2><SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">=20
 to <SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">Houston<FONT=20
 face=3D"Comic Sans MS" color=3Dblack size=3D2><SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'">=20
 (75 miles) for open reduction at a specialist ortho hospital.&nbsp;=20
 
 <SPAN=20
 style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; =
FONT-FAMILY: 'Comic Sans MS'"> <FONT=20
 face=3D"Arial Black" color=3Dblack size=3D2 FAMILY=3D"SANSSERIF"><SPAN =

style=3D"FONT-SIZE: 10pt; BACKGROUND: white; COLOR: black; FONT-STYLE: =
italic; FONT-FAMILY: 'Arial Black'"> Catching=20
 up with the list after a long spell of not being able to read in=20
 detail... Just out of curiosity, how did you clear this =
patient's C=20
 spine clinically, since he had a significant distracting injury as =
well as a=20
 significant mechanism of injury? Any scuff marks on the helmet? IIRC, =
all of=20
 the current protocols specify that patients with both of those factors =

(mechanism and distracting injury) should *not* be cleared in the=20
 field. Got bit on that one a long time ago, with a gal who had =
a=20
 dislocated shoulder from a 4 wheeler wreck. Turned out that the pain =
in the=20
 shoulder was masking neck pain, and follow up films were suspicious =
for a=20
 posterior fracture. We weren't able to do CT at that hospital =
that=20
 weekend, so had to ship her off...I suspect that there was no =
significant=20
 sequelae, as she was lost to follow up, but it did get my pulse to =
rise for a=20
 bit. ck</DIV></BLOCKQUOTE></BODY></HTML>

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