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Tue, 30 Apr 2002 07:16:27 -0700 (PDT)

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 you know, traum should be evaluated as objectively as possible.  lat c-spine is vital to help with initial eval.  yes, physicians should be able to make good clinical decisiions....in patients that can talk and do not have the mechanism of injury most trauma patients have undergone.  missing injury esp to c-spine can be lethal..
here is case.
a car full of people hit a van full of people.  as receiving level one trauma doc, i recieved patients without collars-- no c-spine xray.  ok, the kid had atlanto-occipital disassociation... sucked to be him.  lucky he was neuro intact. he and we all dodged the bullet there. how did we know?   we did a lat c-spine AS SOON AS HE HIT THE ED.  because we know others are sloppy in assessment, cut corners and leave out objective tools for evaluation of trauma patients.
stephanie stafford DO    
  Hiroyuki Hayashi <hhayasi@po2.nsknet.or.jp> wrote: Dear List members,

I'd like to ask members about opinions and evidence regarding importance and
timing of cross table lateral C-spine X-ray in trauma.

We are arguing whether lateral C-spine X-ray is necessary in the
primary survey and resuscitation phase or not.
Some prestigious doctors insist that it should NOT be done in primary survey
unless there is specific reason like maximum precaution for airway
stabilization is necessary due to suspected cervical spine trauma.

They insist that C-spine X-ray finding doesn't change the management as far
as patients are kept secured in C-collar. (I disagree because only C-spine
use without backboard does not provide sufficient immobilization.)
(Maybe yes, but I think if C-spine fracture is identified, it urges maximum
precaution for preventable spinal cord injury)
But they believe this precaution also can be done in secondary survey phase.
Also I think SCI can lead respiratory compromise, and severe C-spine
dislocation without
vital sign can be reasonable early termination of resuscitation.

They claim that initial priority should be focused on bleeding in the most
majority of trauma patients. (I agree) Therefore only chest and pelvic
X-ray
and FAST exam are justifiable test in the primary survey and resuscitation
phase.
Also one of them strongly believes that cross table lateral X-ray takes
significant time during resuscitation. (I disagree. I believe it's quick and
should be done along with chest and pelvic x-ray.)

I believe at least presence of indication for c-spine immobilization is
reasonable indication for cross table lateral C-spine X-ray.

Point is they disagree with me and believe C-spine lateral X-ray should
be done in secondary survey.

Does anybody know plausible evidence regarding necessity and timing of cross
table lateral c-spine X-ray in multiple trauma?
Are there anybody who support the idea of delayed cross table lateral
C-spine x-ray?

RIN
Japan

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<P> you know, traum should be evaluated as objectively as possible.&nbsp; lat c-spine is vital to help with initial eval.&nbsp; yes, physicians should be able to make good clinical decisiions....in patients that can talk and do not have the mechanism of injury most trauma patients have undergone.&nbsp;&nbsp;missing injury esp to c-spine can be&nbsp;lethal..
<P>here is case.
<P>a car full of people hit a van full of people.&nbsp;&nbsp;as receiving level one trauma doc, i recieved patients without collars-- no c-spine xray.&nbsp; ok, the kid&nbsp;had atlanto-occipital disassociation... sucked&nbsp;to be&nbsp;him.&nbsp; lucky he was neuro intact.&nbsp;he and we all dodged the bullet there.&nbsp;how did we know?&nbsp;&nbsp; we did a lat c-spine&nbsp;AS SOON AS HE HIT THE ED.&nbsp; because we know others are sloppy in assessment, cut corners and leave out&nbsp;objective tools for evaluation of trauma patients.
<P>stephanie stafford DO&nbsp;&nbsp;&nbsp; 
<P>&nbsp; <B><I>Hiroyuki Hayashi &lt;hhayasi@po2.nsknet.or.jp&gt;</I></B> wrote: 
<BLOCKQUOTE style="PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #1010ff 2px solid">Dear List members,<BR><BR>I'd like to ask members about opinions and evidence regarding importance and<BR>timing of cross table lateral C-spine X-ray in trauma.<BR><BR>We are arguing whether lateral C-spine X-ray is necessary in the<BR>primary survey and resuscitation phase or not.<BR>Some prestigious doctors insist that it should NOT be done in primary survey<BR>unless there is specific reason like maximum precaution for airway<BR>stabilization is necessary due to suspected cervical spine trauma.<BR><BR>They insist that C-spine X-ray finding doesn't change the management as far<BR>as patients are kept secured in C-collar. (I disagree because only C-spine<BR>use without backboard does not provide sufficient immobilization.)<BR>(Maybe yes, but I think if C-spine fracture is identified, it urges maximum<BR>precaution for preventable spinal cord injury)<BR>But they believe this precaution also can be done in secondary survey phase.<BR>Also I think SCI can lead respiratory compromise, and severe C-spine<BR>dislocation without<BR>vital sign can be reasonable early termination of resuscitation.<BR><BR>They claim that initial priority should be focused on bleeding in the most<BR>majority of trauma patients. (I agree) Therefore only chest and pelvic<BR>X-ray<BR>and FAST exam are justifiable test in the primary survey and resuscitation<BR>phase.<BR>Also one of them strongly believes that cross table lateral X-ray takes<BR>significant time during resuscitation. (I disagree. I believe it's quick and<BR>should be done along with chest and pelvic x-ray.)<BR><BR>I believe at least presence of indication for c-spine immobilization is<BR>reasonable indication for cross table lateral C-spine X-ray.<BR><BR>Point is they disagree with me and believe C-spine lateral X-ray should<BR>be done in secondary survey.<BR><BR>Does anybody know plausible evidence regarding necessity and timing of cross<BR>table lateral c-spine X-ray in multiple trauma?<BR>Are there anybody who support the idea of delayed cross table lateral<BR>C-spine x-ray?<BR><BR><BR>RIN<BR>Japan<BR><BR><BR><BR>--<BR>trauma-list : TRAUMA.ORG<BR>To change your settings or unsubscribe visit:<BR>http://www.trauma.org/traumalist.html</BLOCKQUOTE><p><br><hr size=1><b>Do You Yahoo!?</b><br>
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