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Why is it that sensible statements have to be dragged to the extremes by some people. You cannot ignore spinal injury in your attempt to throw your patient into the hands of the surgeon. On the other hand to delay on scene because you don't want to move the C. spine a millimetre is just as stupid. Where has the common sense gone from this e-group? We all know what we do, why do we take such extremes points of view to argue? Vic Calland Original Message: ----------------- From: Adrian Fogarty [log in to unmask] Date: Sun, 23 Mar 2003 01:12:25 -0000 To: [log in to unmask] Subject: Re: The New GMS contract, GPwSI's, Immediate Care and the Countryside Alliance ----- 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 -------------------------------------------------------------------- mail2web - Check your email from the web at http://mail2web.com/ .