> Precisely, I'm not convinced that immobilisation is strictly
> necessary in
> many of these cases. If the original force that caused the
> fracture did not
> result in a neurological injury, then leaving the patient
> sitting quietly in
> your department is hardly going to lead to a catastrophic
> deterioration.
> It's my belief that patients with cord injury sustain their maximal
> neurological insult at the moment of injury, apart from those
> who undergo
> later passive manipulation of the neck, for example during intubation.
Sounds pretty logical to me. I've still yet to come across a case of a
patient suffering injury between getting in an ambulance and leaving A and E
due to immobilisation not being applied or being removed (although accepting
that intubation etc could be a problem). On the other side, I recently did
come across a case of a junior from another speciality trying to strangle a
patient with a compound unstable bilateral mandibular fracture by putting a
collar on them.
Matt Dunn
Warwick
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