Matt,
Good questions as ever.
For my two pence worth based on personal acute spinal cord injury
management, all such patients that I have had direct involvement have had
evidence of spinal cord injury at the time they were found. In my view the
spinal cord is like the brain - it is usually directly injured at the time
of significant impact. There is always the potential for secondary
injury.... but I have yet to have seen this clearly established in any
individual patient.
To pick up a related thread that was covered on trauma.org recently could I
pose this question to this list:
Should unconscious patients be managed in the field any differently by
untrained bystanders (as first responders) irrespective of whether they have
in fact sustained head/neck injury?
I am particularly interested in the airway management issues.
Does the current advice (UK resus. guidelines) in fact do more harm than
good?
John Black
Oxford
Useful questions for study:
1. Are spinal cords ever injured from 'normal' movement in A and E
departments/ wards (as opposed to during extrications)?
2. Does spinal 'immobilisation' prevent this (and I am aware of studies
suggesting that longboards or collars have little effect on movement of the
unstable neck) and if so, what are the effective interventions?
3. What is the incidence of serious side effects (raised ICP, pressure sores
etc.) from each of these interventions.
Has anyone done a formal literature review?
Matt Dunn
Warwick
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