trauma-list Digest, Vol 103, Issue 12

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Ron

We remove collars after normal CT in obtunded patients - we have also not
had any missed injuries of clinical signficance. There are not enough MRI
scanners to this for all of them.

As to whether to scan the patient in your hospital - this should be guided
by one's local system: if the system is set up with modern scanners and
transfer may be delayed, then by all means scan the patient who is stable
enough to wait, especially if the hospital has a surgeon who could
intervene, or the facility to fax the scan for the (far away) neurosurgeon
to review (a common developing world situation). Sanity and balance must
prevail, however it should never be a pre-requisite for transfer.

Tim
Dr T C Hardcastle
M.B., Ch.B. (Stell); M. Med. (Chir) (Stell); FCS (SA)
Principal Specialist Trauma Surgeon /
Honorary Senior Lecturer UKZN Dept Surgery
Deputy Director - IALCH Trauma Service
Durban, South Africa
> I would agree with you; interestingly, one of my partners and I make
> "C-collar" rounds in the ICU, removing collars in comatose patients with
> normal CT scans of the c-spine, while other partners are now spooked by
> the updated and now more nebulous EAST guidelines regarding cervical spine
> clearance and removal of the collar:
>

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