this and that - Cervical Paranoia

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Hi all,

So with CT you have safely excluded bone injuries, and you have no
neurological deficits on physical exam. However, the patient has midline
pain. This leaves you with two possibilities: or you have a insignificant
soft tissue injury, or you have a more serious ligamentous injury.

If you consider a ligamentous injury in a patient without neuro deficit,
taking the collar off can be of no harm, since no active or passive movement
of the spine could cause a greater anatomical disruption than the initial
trauma (like hyperflexion in a frontal car crash). If the cervical
instability caused by ligament rupture could harm the medulla, it would have
already done it.

So, treatment is the same. Neck pain, no deficit, and normal CT: a Schantz
collar to minimize movement and that´s it. Some NSAIDs.

Flexion/extension views in this scenario become useless if you see it this
way. You could even see some cervical disalignment on active or passive
flexion, but there would be nothing to be done. This disalignment does not
cause spinal canal narrowing.



And about the other topic: inadequacy of plain x-ray films in unconscious
patients, I totally agree. CT must be the first choice.


Cheers,

Felix.

HPS - POA
Emergency Medicine
Brazil.


----- Original Message -----
From: "Andrew J Bowman" <sumieb at compuserve.com>
To: "Trauma & Critical Care mailing list" <trauma-list at trauma.org>
Sent: Sunday, October 09, 2005 9:25 PM
Subject: Re: this and that


> So you have a awake and alert patient, has midline tenderness, no
peripheral
> deficits, normal 3 view plain films and normal CT.
>
> Does that clear the c-spine?  Do you need flexion/extension (passive or
> active)?
>
> Andrew Bowman
>
> ----- Original Message -----
> From: <DocRickFry at aol.com>
> To: <trauma-list at trauma.org>
> Sent: Sunday, October 09, 2005 7:08 PM
> Subject: Re: this and that
>
>
> >
> >
> > In a message dated 10/9/2005 4:06:58 P.M. Eastern Daylight Time,
> > joe.nemeth at staff.mcgill.ca writes:
> >
> > YOU  cannot clear the C Spine with a lateral....therefore no removal of
> > collar
> > till the 3 views are done and  read...
> >
> >
> >
> >
> > Again--this does NOT clear the c-spine!  Only absence of tenderness on
> exam
> > does that!
> > ERF
> > --
> > trauma-list : TRAUMA.ORG
> > To change your settings or unsubscribe visit:
> > http://www.trauma.org/traumalist.html
> >
>
>
> --
> trauma-list : TRAUMA.ORG
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>

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