Yes John, I believe any cord injury will happen at the moment of impact;
it's highly unlikely that the patient will cause further damage in the ED.
Like any unstable fracture, the forces causing deformity are maximal upon
impact. Like you, I've never seen a definite exacerbation of cord injury in
the ED. By the same token the patient who is mobilising at the scene is
extremely unlikely to come to harm in the ED, so I get peeved when they
arrive immobilised, or even worse when they get immobilised by the triage
nurse.
In my book the airway takes absolute priority over c-spine. I have no
hesitation in relaxing c-spine immobilisation to facilitate improvement of
airway patency or protection. Conversely to allow compromise of the airway
in order to protect a "potential" c-spine injury seems to me to be just
plain stupid.
Adrian Fogarty
----- Original Message -----
From: "Black, John" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Friday, September 13, 2002 1:51 PM
Subject: Spinal cord injury risk
> 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
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