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Sun Feb 5 20:08:11 GMT 2012

PHTLS teaches "Judgment based on Knowledge". The "indications for spinal
immobilization" are on page 257 of the 7th edition (military) and about
the same place for the civilian edition. I do not h a copy of it at
home. 

For Dr Mattox, It includes do not immobilize for penetrating trauma
unless and neurologic deficit or complaint is present

Norman

Norman McSwain MD, FACS
Professor of Surgery, Tulane University
Trauma director, Spirit of Charity Trauma Center, ILH
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of McSwain, Norman E
Sent: Sunday, February 05, 2012 2:01 PM
To: Trauma-List [TRAUMA.ORG]
Subject: RE: Cervical Injuries & Cervical Collars

I would point out that this is what PHTLS has taught for the last two
editions

Norman

Norman McSwain MD, FACS
Professor of Surgery, Tulane University
Trauma director, Spirit of Charity Trauma Center, ILH
504 988 5111

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of john Wood
Sent: Sunday, February 05, 2012 1:53 PM
To: Trauma-List [TRAUMA.ORG]
Subject: Re: Cervical Injuries & Cervical Collars

In the UK there is an increasing move away from 'mandatory' spinal
immobilisation in the out of hospital environment. Practice varies, but
the thinking application of NEXUS and or Canadian C Spine rules is
beginning to take precedent over unthinking application of collars 

John 

On 5 Feb 2012, at 19:44, "Jel Coward" <jel at wildmedic.org> wrote:

> Time to make it non-standard perhaps.
> 
> Jel via Android
> On Feb 5, 2012 11:42 AM, "johnleslie48" <johnleslie48 at gmail.com>
wrote:
> 
>> Yes. Well said. But do you nevertheless feel constrained by lawyers 
>> if nothing else,  to take "all due standard precautions"??
>> 
>> John Leslie
>> 
>> 0412 528851
>> 
>> Sent from my iPhone
>> 
>> On Feb 6, 2012, at 6:31, KMATTOX at aol.com wrote:
>> 
>>> I apologize for not posting more on this subject.   Yesterday  while
I
>> was
>>> on call in the hospital , not only was I interrupted too   many
times,
>> but
>>> my  comments soon became longer than a book chapter and  actually 
>>> became
>> 6
>>> different chapters on the issues we face with cervical  injury.
>>> 
>>> Anatomically  the neck is among the most complex regions we face to 
>>> evaluate and treat when it is injured or thought to be  injured.
>>> 
>>> We put all sorts of things ON the head, around the neck, and 
>>> surrounding the body, all of which are very  dynamic during our 
>>> injury  production mechanisms.
>>> 
>>> We really do not know what the words mean that we use to describe
>> injury.
>>> For instance a CTA (or even arteriogram) demonstrated  carotid 
>>> artery "dissection", has never been pathologically  reported,  AND 
>>> dissection
>> of the
>>> carotid is NOT the same thing as a dissection in the  aorta.
Different
>>> pathologies, and yet we co-use the  words.
>>> 
>>> We cannot agree on the optimal best practice for evaluation and 
>>> classification and temporary  treatment, with simple drugs like 
>>> Heparin,
>> Coumadin,
>>> and Plavix as it relates to cervical injury.
>>> 
>>> The dynamics of soft tissue and bony injury to the neck make 
>>> fractures, ligamentoous injury, and nerve stretches at the top of 
>>> the neck  totally different from those at the thoracic  outlet.
>>> 
>>> I remember well the initial ATLS courses teaching neck stretching by
>> using
>>> Gardner-Wells tongs attached to weights on a spine bed frame.     We
>> taught
>>> this skill using coconuts..    Many of us now shutter  to think that
this
>>> was taught as the best practice.
>>> 
>>> Over arching over the medicine, often practiced with little science,

>>> is
>> the
>>> economics of selling cervical collars and back boards.    While
there is
>>> some logic from the testimonals from their application, the science
is
>>> sparse.      I have often been a critic of  cervical collars, but
now I
>> am ot
>>> really sure just what is right and just where  and when should they 
>>> be
>> applied
>>> and when to take off.      Last night I had a patient with a gun
shot
>> wound
>>> to the soft tissue of the right  leg who came in with a tightly
applied
>>> cervical collar.   Go  figure.
>>> 
>>> So, instead of your having to read a chapter for each of these 
>>> paragraphs above, I will now quietly fade back into the lurker land.
>>> 
>>> k
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