Cx collar GSW neck

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you can't treat the wound completely, if you do not understand the ballistics
 
Norman
 
Norman McSwain MD
Trauma Director, Charity Hospital
Professor of Surgery, Tulane University
New Orleans LA
504 988 5111
norman.mcswain at tulane.edu <mailto:norman.mcswain at tulane.edu> 

________________________________

From: trauma-list-bounces at trauma.org on behalf of Bjorn, Pret
Sent: Mon 8/24/2009 10:10 AM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Cx collar GSW neck



Dr. McSwain,

You're the surgeon; but I've seen more fussing and fouling-up associated
with ballistics expertise than ameliorated by it.

Pret's Short Course on Ballistics for the Healthcare Provider:

1: Firearms -- specifics of ballistics notwithstanding -- are designed
chiefly to damage kill things.

2: The "facts" related to any GSW in real time are sketchy if not
downright apocryphal.  In my experience, unless a cop or soldier shot
your patient, and is there to tell you about the bullet, the nature of
the gun or bullet are a complete crapshoot.

3: Treat the wound, not the weapon, with attention to #'s 1 and 2 above.

Pret


-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
Jr.
Sent: Monday, August 24, 2009 9:25 AM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Cx collar GSW neck

You can  treat the wound much better if you understand the
ballistics....especially in the operating room. Two recent medical legal
cases the I have been involved in (not here) were missed because the
providers did not understand. The patients died because of this
oversight

Of course medical legal is not what we are interested in. Patient is
what we are about but these are examples of the benefit of knowing as
much about the patient's injuries as possible.

Understanding ballistics provides that knowledge

PHTLS motto " judgement based on knowledge"

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 Bjorn, Pret
Sent: Monday, August 24, 2009 7:43 AM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Cx collar GSW neck

With penetrating injury, there is zero incidence of bony instability in
the absence of neurologic signs.  I haven't even been able to find a
reliable anecdote.

The collar is not indicated, delays more appropriate objectives,
obscures the wound, and arguably jeopardizes the airway.

Ballistics -- as always, in my experience -- lends nothing meaningful to
the discussion.  You'll do fine in your clinical career if you never
again fret over caliber and muzzle velocity and pitch and yaw and tumble
and cavitation.  Treat the wound, not the weapon.

Pret Bjorn, RN
Bangor, ME USA

-----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 5:31 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


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