Yes
Simon & Fiona Carley
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----- Original Message -----
From: "Black, John" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, May 08, 2003 1:27 PM
Subject: Re: pre-hospital spinal control - steroids
> Is everyone using steroids (within 8 hours of injury) in those with spinal
> fractures & spinal cord injury?
>
> John Black
> Oxford
>
> -----Original Message-----
> From: Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR
> [mailto:[log in to unmask]]
> Sent: 08 May 2003 09:55
> To: [log in to unmask]
> Subject: Re: pre-hospital spinal control
>
> > In other words, paralysis following RTA with extrication is
> > highly likely to
> > have occurred as a result of the RTA, not the extrication. If
> > the energy of
> > the accident was sufficient to fracture the vertebrae and rupture the
> > interspinous ligaments, it's hardly going to be insufficient
> > to damage the,
> > now unsupported, spinal cord. And the test in civil law relies on the
> > balance of probabilities, so as long as the former is more
> > likely than the
> > latter (>50%) then a court will find in favour of the former scenario.
>
> I can imagine a scenario in which a spinal cord could be compressed by
> fragments from a burst fracture and further movement would cause
additional
> damage- and certainly additional swelling with damage to the blood supply.
> Analogous to long bone fractures where movement after the fracture can
cause
> additional soft tissue injury (and indeed the pain which suggests release
of
> inflammatory mediators likely to cause swelling).
> If you have good documentation that paralysis was present prior to
> extrication (and doing a full neuro exam prior to extrication is not good
> practice) you'd have a defence, but otherwise I reckon you could find
> yourself up against a spinal surgeon (who would tend to carry more weight
> than one of us as a causation expert) who could convince the court of the
> above scenario.
>
> If caught in that situation, I'd probably rely on a Bolam defence on the
> basis that not stabilising the spine was an accepted practice. There
> certainly is a reasonable body of (if a minority) opinion that holds that
> rapid extrication to care for suspected life threatening injuries takes
> priority over spinal cord control with the methods generally available.
>
> Matt Dunn
> Warwick
>
>
>
>
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