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Mon Aug 24 14:15:20 BST 2009

Do not use a collar on me. It provides no benefit. Several papers have shown that. One from here

Norman

Norman McSwain MD
Professor, Tulane School of Medicine
Trauma Director, Charity Hospital Trauma Center
norman.mcswain at tulane.edu
504 988 5111
-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org] On Behalf Of Christos Giannou
Sent: Monday, August 24, 2009 4:31 AM
To: trauma-list at trauma.org
Subject: Cx collar GSW neck

QUOTE
Question if I understand what your saying  If the patient has a GSW to the
neck do not use a c-collar. What if they were shot with a small
caliber\medium to high velocity gun in the neck and ricochet up and down the
spinal column. Please explain for educational reasons
UNQUOTE

Norman McSwain gives the simple answer: "The damage is already done.
Immobilization will not prevent it worsening."

Furthermore, forget the calibre and velocity. Whatever they may have been at
exit from the muzzle of the gun, you have no idea of what they were at the
moment of impact (ricochet of the bullet before hitting the body can change
the mass and certainly its instability and wounding potential) and therefore
the potential kinetic energy contained by the bullet. You have less
information on the kinetic energy effectively transferred to the tissues and
the tissue-projectile interaction. In addition, an understanding of
tissue-projectile interaction (inertial forces, tissue elasticity or lack
thereof, resistance to deformation of tissues etc) will tell you that the
bullet CANNOT ricochet up and down the spinal column. The classical cliché:
"Treat the wound, not the weapon" (Lindsey D. The idolatry of velocity, or
lies, damn lies, and ballistics. J Trauma 1980; 20: 1068-1069.) is not a
vain concept. Therefore, the wound, as Norman wrote: "The damage is already
done."

-- 
christos giannou
Monemvasia Lakonia
23070 Greece
tel & fax: (++30) 27320-61772
mob: (++30) 69 74 83 28 18
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Cx collar GSW neck