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Removing the collar

Don Benson bensonblues at comcast.net
Mon Oct 10 07:24:39 BST 2005


At our institution, a cross-table lateral film and AP film is taken through
the collar. The radiologist eventually reads the film, but in the mean time
images are available to be read immediately by the EP and surgeon on a flat
screen monitor near the patient care area. If a problem is suspected, the
collar remains on and a CT is obtained. If there is low probability of
unstable injury, the collar is removed and the series is completed. The
collar is replaced after the images are obtained and the patient is returned
to the ED. The EP or surgeon them re-evaluates the patient and either clears
the c-spine and removes the collar, or keeps the collar on and obtains a CT.
If the patient is comatose, however, the collar remains on to keep the neck
straight and facilitate venous drainage from the head.

The point is that the collar can be removed if someone competent can hold
the head while images are being obtained, but it is up to the clinician (EP
or surgeon) to clear the c-spine and remove the collar for good, not the
radiologist. Radiographs which are negative for fracture or dislocation may
not immediately reveal evidence ligamentous injury - which has the potential
of being an entirely unstable situation for the cervical spinal cord.

Don B
bensonblues at comcast.net

-----Original Message-----
From: Andrew J Bowman [mailto:sumieb at compuserve.com] 
Sent: Sunday, October 09, 2005 11:57 AM
To: Critical Care Medicine Listserv
Cc: Trauma List
Subject: Fw: Removing the collar

What of this situation that I experience daily in my ED? Patient arrives
from whatever mechanism of trauma with neck collar in place. Awake, alert,
moves everything well.  Complains of neck pain and so goes for cross table
c-spine. Gets read as normal by EDP and/or radiologist.  Rad tech is told to
remove the collar for the AP and odontoid views but then to put the collar
back on before coming back to ED. My position is that once the collar is off
why put it back on and if we are putting it back on why are we allowing it
to be removed in the first place??? Any takers?
Andrew Bowman

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