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Mon Oct 10 15:50:36 BST 2005

Good question, but none of this has yet been studied in children to allow any answers to be reliable--it is clearly known that plain films miss the greatest number of spine injuries of any patient group--50% on average--we use CT only to evaluate.  Phys exam is still acceptable, but harder in young children to know whether they are tender or not--so more reliance on imaging
ERF 

-----Original Message-----
From: Mary Jo Quintero <MQuintero at CHILDRENSCENTRALCAL.ORG>
To: trauma-list at trauma.org
Sent: Mon, 10 Oct 2005 05:34:14 -0700
Subject: RE: Removing the collar

Which cervical collar are you using that is radiolucent?  

Also, with this thread, can you comment opinions for the pediatric
patient.  Suppose the patient discussed below is 4 years old?  

Thanks.

Mary Jo Quintero, RN, CCRN
Critical Care Transport Services
Transport Coordinator, PICU
559.353.8661
Water Safety Program 
559.353.8770
mquintero at childrenscentralcal.org

>>> bensonblues at comcast.net 10/09/2005 11:24:39 PM >>>
Andy,

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
SJHMC
Detroit
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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Removing the collar