>From: "Adrian Fogarty" <[log in to unmask]>
>Ignoring the accident mechanism is rather defeatist, isn't it? Conscious
>patients can usually give a clear history except in very high energy
>impacts
>where there is often transient amnesia (unrelated to concussion).
>
>My main point is that we CAN infer risk of neck injury from a careful
>history of the accident mechanism together with a rudimentary understanding
>of accident mechanics; to simply x-ray everybody who has been involved in
>trauma regardless of the mechanism would render us redundant, while
>exposing
>patients to unnecessary radiation, and clogging up our departments etc.etc.
>
A further minor point (have referred to others in previous e-mail). I
believe that many patients who have neck pain in these circumstances and are
not X-rayed will eventually get an X-ray from GP/re-visit to A&E, because
symptoms often persist and someone ends up requesting it. So any saving in
"unnecessary radiation and clogging up" might be false/temporary.
>I know this is my personal approach (in the real world!), but that's how
>many of us work in this business.
>
>Regards
>
>Adrian Fogarty
>A&E Consultant
>Royal Free Hospital
>
>
>----- Original Message -----
>From: Sam Waddy <[log in to unmask]>
>To: <[log in to unmask]>
>Sent: Sunday, August 27, 2000 8:55 PM
>Subject: Re: Necks in A&E
>
>
> > In message <000701c00fb4$8ccf4e20$3150073e@ji1l6>, Adrian Fogarty
> > <[log in to unmask]> writes
> > >I agree with Stephen; falls are very high risk, and small falls can be
> > >riskier because they are often overlooked.
> >
> > Which is the reason, I presume, why lots of X-ray guidelines don't
> > include injury mechanism, because when we get to see the patients we
> > haven't seen the accident, and make all sorts of assumptions about the
> > "mechanism" of injury which may be completely wrong, thus safer to
> > assume nothing about the mechanism.
> >
> > The point is that the mechanism of injury to the SPINE is what forces go
> > through the C-spine, not what go through the car/crash cage/seat or lack
> > of these when coming off your horse/bike. We are not good at guessing
> > the former from the latter.
> >
> > --
> > Sam Waddy
> > SHO Oxford (ex A&E and can't wait to get back one day!)
> >
>
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