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trauma-list Digest, Vol 103, Issue 12

jrhmdtraum at aol.com jrhmdtraum at aol.com
Tue Jan 31 12:08:28 GMT 2012


The literature and the experiance of others would disagree with you.  A CT will not pick up a ligament injury.  They are rare - but the reason you do flexion extension xrays in the awake patient.

We would disagree with your statement about keeping comatose patients 
immobilized after a normal CT.
We have been routinely discontinuing spinal precautions in comatose patients 
after normal CT for almost 10 years now in our high volume major trauma centre.
It is stated in our spinal clearance guidelines. We have not had a major missed 
injury resulting in permanent damage. 
A few patients complain of neck pain after extubation, prompting an MRI. We 
occasionally find a minor missed injury, but never with long term sequelae.
We find MRI too slow and too expensive to use routinely. We also find that 
leaving the collars on and patient flat?too long leads to increased occipital 
pressure ulcers, poorer hygeine, and increased VAP.
Julie Miller
Melbourne, Australia

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