Hi all
......I know, I know, I'm brain picking again.....sorry.
There is a thing called the Canadian C-spine Rule.
We are trying to come up with some guidelines for practice in the
Canadian rurality, which as I am sure you can imagine, can be quite rural.
I have a problem with the Canadian C-spine Rule in that it mandates
c-spine xray (for many of us, immobilisation and transfer to a facility
that has 24 hour x-ray - perhaps hours away - perhaps a flight away)
based on _dangerous mechanism of injury_ alone.
It describes a 'dangerous mechanism' as being
- fall > 3 ft / 5 stairs
- axial load to head eg. diving
- MVC high speed (>100km/hr), rollover, ejection
- motorised recreational vehicles (snowmobiles, ATVs, I think is meant)
- bicycle collision
It _mandates_ (it labels itself a Rule) - radiography of the neck for
all of the above.
Which seems a bit daft. I not infrequently see the ATV rollover guy or
gal who rolls their machine in the hills, rights it, gets back on,
rides out and comes in because they thing they sprained their thumb when
it happens - otherwise asymptomatic and meeting NEXUS criteria - or
similar scenarios.
I have a colleague saying 'no, no, no we must use the Canadian C-spine
rule in our teaching because it is the only 'rule' based on a
_prospective_ study'.
So.......how far off am I suggesting that we do what many ambulance
services do, and emerg depts (I think) do - and use a clinical criteria
based assessment tool rather than one that mandates x-ray based on 'what
happened' (and not necessarily, what happened to the patient, either).
Thoughts would be very welcome please - either way.
Lastly - is the Can C-spine rule being used much in the UK and elsewhere?
Thanks all :)
Cheers
Jel
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