I agree with Stephen; falls are very high risk, and small falls can be
riskier because they are often overlooked. I have seen many neck fractures
from the elderly or drunk patient tripping down 2 or 3 steps at home and
falling onto their head/face. In some of these cases, the prehospital folk
failed to think of neck injury, presumably because there wasn't a dramatic
smash-up. Unfortunately this false sense of security continued into the
hospital phase with the expected consequences. Conversely patients from RTAs
are invariably collared and strapped as their vehicles are impressively
damaged, but on closer analysis many of these patients are really very low
risk for c-spine fracture as I explained earlier.
Adrian Fogarty
A&E Consultant
Royal Free Hospital
----- Original Message -----
From: S A Hughes <[log in to unmask]>
To: Gautam <[log in to unmask]>
Cc: <[log in to unmask]>
Sent: Saturday, August 26, 2000 4:58 PM
Subject: Re: Necks in A&E
> >Anyone fancy doing a "best BETS" on the clinical question:
> >A 17 year old woman falls off her horse / had a low-impact RTA, is not
knocked
> >out,
> >has no neuro features, no distracting injuries, no midline neck
tenderness but
> >has a
> >10% reduction of neck movements due to slight discomfort at extremes of
> >movement.
> >You order a C-spine Xray according to guidelines. You wonder what the
chance is
> >of a
> >significant positive finding on the XRay?
> >
> >Dr G Ray
> >Staff Grade
> >A&E
> >Sussex
> >Reply to [log in to unmask]
>
> A low speed RTA is not the same as a fall from a horse. In my view, all
> falls from these dangerous beasts involve significant injury.
>
> Like must be compared with like. In these two cases, the forces involved
> are quite different. (see Mr Fogarty's posting)
>
> The horsewoman should be xrayed and her hideous fracture/dislocation
> demonstrated. The car driver is probably only there for documentation
> for litigation purposes. The purpose of irradiating this latter group is
> to stop them breeding.
>
> There are, of course exceptions. If I do not find an injury after a
> horse-related accident, I sleep poorly.
>
> I shall feed this into my BET machine and see what comes up with regard
> to the driver. I won't do it for the equestrian because no good ever
> came from BETting on horses.
> --
> Stephen Hughes
> SpR Harlow
>
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