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Surely the published evidence is clear - clinical findings are reliable in this patient and no x rays are required to clear the neck - normal consciousness, no drugs or alcohol, no neurology or distracting injury. No immobilisation is required, proceed with crash section - in the emergency department. However, if she was in active labour, presumably that could act as a distracting pain and x rays would then be required to rule out injury - , of the whole spine if mechanism suggestive. Anyone ever been present at a crash section where full spinal immobilisation was attempted? > ---------- > From: Gautam Ray[SMTP:[log in to unmask]] > Sent: 05 September 1998 23:17 > To: [log in to unmask] > Subject: ATLS, late pregnancy and XRays. > > Case report and question: > > 38-week pregnant driver, RTA. GCS=15 throughout. Mum had NO pain, nor > any sign of injury clinically. Her obs were absolutely fine and she > was > neurologically intact. Obstetricians / Midwife ready and waiting when > she arrived (the paramedics had let us know in advance - bless them). > By > the time the baby-doctors had decided that the foetal heart was > worryingly bradycardic, mum's primary survey was just finished, large- > bore lines in either arm, fluids running, bloods off, oxygen on. The > obstetricians were ranting and raving by this stage, demanding to wisk > her off to theatre for an immediate baby-ectomy, but the trauma team > leader insisted on proceeding with the trauma series first (at least > 10 > minute delay). > > Question: > Bearing in mind that Mum was completely awake, with stable obs and no > sign of injury AT ALL and that the only thing amiss was a slow baby, > would you have sided with the obstetric department or the trauma team > re. XRays? > > Outcome: > Tauma series was done, all NAD. Crash LSCS resulting in healthy baby > and > Mum. Small tear in placenta noted at op, presumed cause of foetal > distress. > ====================================================================== > ===== > Goat > (e-mail: [log in to unmask]) > Sussex, U.K. > ---------------------------------------------------------------------- > -------- > To err is human, to forgive is not management policy > ---------------------------------------------------------------------- > -------- > %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%