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Fri Aug 21 17:39:08 BST 2009

Sorry if I seem obtuse, but why should a reverse trendelenburg impose
less of a load/distortion on the c-spine than a head of bed raise?
you still have the head on top, the c-spine below, and the same angle
to the c-spine in both cases, dont you? the flexion in a head of bed
raise takes place at the hip. Why should that cause any extra problems
to the c-spine compared to a reverse t-burg?
rangraj

On 8/21/09, Gross, Ronald <Ronald.Gross at baystatehealth.org> wrote:
> Yes - to 30 degrees. And I do not know the data, but we do just that with all our vented patients unless the neuro/ortho guys insist that we can't for the really, really  bad dorsal spine injuries.
>
>  RIG
>
>
>  -----Original Message-----
>  From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of moore677 at aol.com
>  Sent: Thursday, August 20, 2009 4:55 PM
>  To: rcoimbra at ucsd.edu; trauma-list at trauma.org; phpatel at yahoo.com; hoffW at slhn.org; sluk at harthosp.org; hoeyB at slhn.org; jduchesn at tulane.edu; hphela at yahoo.com; rhmt99 at yahoo.com; CVRBrown at seton.org; tloftus at cox.net; CHu at SHC.org; fgiberson at christianacare.org; thiessen05 at gmail.com; eshweiki at christianacare.org; mcipolle at christianacare.org; adam.shiroff at uphs.upenn.edu; adam.fox at uphs.upenn.edu; gfulda at christianacare.org; dellinger-phil at cooperhealth.edu; McQuayN at slhn.org; tokeeffe at mac.com; prhee at surgery.arizona.edu; Patrick_ONeill at medprodoctors.com; marc_matthews at medprodoctors.com; v3bansal at ucsd.edu; Jordy_Cox at medprodoctors.com; CSimpk at lsuhsc.edu; karmy at myuw.net; barnesste at health.missouri.edu; snorwo01 at msn.com; srpmdpc at sprynet.com; heidi.frankel at utsouthwestern.edu; peitzmanab at upmc.edu; trauma-list at trauma.org
>  Subject: Re: C-SPINE CLEARANCE AND ELEVATION OF HOB
>
>
>  Even if full spine precautions (until cleared), could you safely place a patient in reverse T-burg, getting the benefit of "elevating HOB" essentially and theoretically decrease risk of aspiration?
>
>
>
>  Dell.................
>
>
>
>
>
>
>  -----Original Message-----
>  From: Coimbra, Raul <rcoimbra at ucsd.edu>
>  To: moore677 at aol.com; trauma-list at trauma.org; phpatel at yahoo.com; hoffW at slhn.org; sluk at harthosp.org; hoeyB at slhn.org; jduchesn at tulane.edu; hphela at yahoo.com; rhmt99 at yahoo.com; CVRBrown at seton.org; tloftus at cox.net; CHu at SHC.org; fgiberson at christianacare.org; thiessen05 at gmail.com; eshweiki at christianacare.org; mcipolle at christianacare.org; adam.shiroff at uphs.upenn.edu; adam.fox at uphs.upenn.edu; gfulda at christianacare.org; dellinger-phil at cooperhealth.edu; McQuayN at slhn.org; tokeeffe at mac.com; prhee at surgery.arizona.edu; Patrick_ONeill at medprodoctors.com; marc_matthews at medprodoctors.com; Bansal, Vishal <v3bansal at ucsd.edu>; Jordy_Cox at medprodoctors.com; CSimpk at lsuhsc.edu; karmy at myuw.net; barnesste at health.missouri.edu; snorwo01 at msn.com; srpmdpc at sprynet.com; heidi.frankel at utsouthwestern.edu; peitzmanab at upmc.edu
>  Sent: Thu, Aug 20, 2009 1:48 pm
>  Subject: RE: C-SPINE CLEARANCE AND ELEVATION OF HOB
>
>
>
>
>  Our c-spine precautions protocol allows 30 degree head of the bed elevation. Full spine precaution does not.
>
>  RC
>
>  ?
>
>  Raul Coimbra, MD, PhD, FACS
>
>  The Monroe E. Trout Professor of Surgery
>
>  Chief, Division of Trauma, Surgical Critical Care, and Burns
>
>  University of California San Diego School of Medicine
>
>  ?
>
>
>  From: moore677 at aol.com [mailto:moore677 at aol.com]
>  Sent: Thursday, August 20, 2009 1:30 PM
>  To: trauma-list at trauma.org; phpatel at yahoo.com; hoffW at slhn.org; sluk at harthosp.org; hoeyB at slhn.org; jduchesn at tulane.edu; hphela at yahoo.com; rhmt99 at yahoo.com; CVRBrown at seton.org; tloftus at cox.net; CHu at SHC.org; fgiberson at christianacare.org; thiessen05 at gmail.com; eshweiki at christianacare.org; mcipolle at christianacare.org; adam.shiroff at uphs.upenn.edu; adam.fox at uphs.upenn.edu; gfulda at christianacare.org; dellinger-phil at cooperhealth.edu; McQuayN at slhn.org; tokeeffe at mac.com; prhee at surgery.arizona.edu; Patrick_ONeill at medprodoctors.com; marc_matthews at medprodoctors.com; Coimbra, Raul; Bansal, Vishal; Jordy_Cox at medprodoctors.com; CSimpk at lsuhsc.edu; karmy at myuw.net; barnesste at health.missouri.edu; snorwo01 at msn.com; srpmdpc at sprynet.com; heidi.frankel at utsouthwestern.edu; peitzmanab at upmc.edu
>  Subject: C-SPINE CLEARANCE AND ELEVATION OF HOB
>
>
>  ?
>
>
>  Along the lines of VAP, is anyone aware of any data that precludes placing the patient in steep reverse Trendelenburg (>30 to 45 degrees) when we are unable to clear the patient's C-spine (and thus elevated HOB), in an effort to decrease aspiration?
>
>
>
>  ?
>
>
>
>  ?
>
>
>
>  Dell...............
>
>
>
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-- 
Lt Col Rangraj Setlur
Classified Specialist-Anaesthesia and Critical Care
India

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C-SPINE CLEARANCE AND ELEVATION OF HOB