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Tue May 12 20:06:22 BST 2009

I've actually seen this in person.  It's one of my favorite teaching
anecdotes: 

Back in the days of plain films, old fellow with neck pain from a minor
MVC the week before, seen twice at different hospitals, two sets of
five-view c-spines, all read as degenerative changes and spondylolysis,
gradually increasing narcotics, finally got a good deep sleep, awakened
to the sensation of his head falling off his neck.  Arrived to the ED,
POV (well, technically a Wife-Operated Vehicle), looking like McCaulay
Culkin in the "home alone" pose.  

The upper spine is roomy and relatively forgiving.

Pret

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Krin135 at aol.com
Sent: Tuesday, May 12, 2009 2:52 PM
To: trauma-list at trauma.org
Subject: Re: C-Spine Clearance by
EDTriageNurses_CAUTION-------------------------------

actually, the first article I cited when I changed the subject line to  
"Internal Decapitation," showed that in their small series (6 patients),
there  
was significant muscular splinting *as long as the patient was not
placed 
under  anesthesia*. This goes along with my professional experience over
the 
last 20  years, including two cases of 'clay shoveler's fracture,' where
the 
patients  (separately) came to the ED holding their heads with their own

hands, and  complaining of neck pain...

in case you missed it, Pret:

Internal Decapitation: Survival After Head to  Neck Dissociation
Injuries
Ben-Galim, Peleg J. MD; Sibai, Tarek A. MD; Hipp,  John A. PhD;
Heggeness, 
Michael H. MD, PhD; Reitman, Charles A. MDSpine: 

Spine 15  July  2008 - Volume 33 - Issue 16 - pp 1744-1749
doi:   10.1097/BRS.0b013e31817bb0e0

it's available on Medscape.

ck
Charles S. Krin, DO

In a message dated 5/12/2009 12:33:00 Central Standard Time,
pbjorn at emh.org 
 writes:

Finally,  the data may or may not show fracture mobility in a cervical
collar; but  most of the data are from thoroughly relaxed injury  models
(cadavers).  And there is little if any evidence of  preventable
iatrogenic injury among collar wearers in  vivo.

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C-Spine Clearance by EDTriageNurses_CAUTION-------------------------------