----- Original Message -----
From: "Jel Coward" <[log in to unmask]
>
> Adrian Fogarty writes:
> >To be precise, ATLS now cautions against wasting time clearing the
c-spine
> >where the patient is unstable, particularly in cases of penetrating
trauma
> >(where it questions the need to clear the c-spine at all).
>
> Oddly I think ATLS here in Canada must be one version behind yours
> because this does not feature - they are using the 97 manual
> Jel
No, we're using the same version, Jel, and I quote:
"X-rays should be used judiciously and should not delay patient
resuscitation or transfer. The chest and pelvis films provide information
that can guide resuscitation efforts of the patient with blunt trauma. A
lateral cervical spine x-ray that demonstrates an injury is an important
finding whereas a negative or inadequate film does not exclude cervical
spine injury... These films can be taken in the resuscitation area but
should not interrupt the resuscitation process...During the secondary
survey, complete cervical spine films may be obtained if the patient's care
is not compromised and if the mechanism of injury suggests the possibility
of spinal injury...As long as the patient's spine is protected, evaluation
of the spine and exclusion of spine injury may be safely deferred,
especially in the presence of systemic instability."
Basically, Jel, this represented a significant move away from mandatory
c-spine imaging in the resus room which is how ATLS was peddled prior to
1997. Although there is no specific mention of c-spine imaging in
penetrating trauma, most instructors now interpret this issue under the
clause: "if the mechanism of injury suggests the possibility of spinal
injury". For practical purposes then, most workers do not worry about the
c-spine in penetrating torso trauma. Perhaps the Canadians are interpreting
this differently, Jel, I don't know...
Adrian Fogarty
|