Ignoring the accident mechanism is rather defeatist, isn't it? Conscious
patients can usually give a clear history except in very high energy impacts
where there is often transient amnesia (unrelated to concussion).
My main point is that we CAN infer risk of neck injury from a careful
history of the accident mechanism together with a rudimentary understanding
of accident mechanics; to simply x-ray everybody who has been involved in
trauma regardless of the mechanism would render us redundant, while exposing
patients to unnecessary radiation, and clogging up our departments etc.etc.
I know this is my personal approach (in the real world!), but that's how
many of us work in this business.
Regards
Adrian Fogarty
A&E Consultant
Royal Free Hospital
----- Original Message -----
From: Sam Waddy <[log in to unmask]>
To: <[log in to unmask]>
Sent: Sunday, August 27, 2000 8:55 PM
Subject: Re: Necks in A&E
> In message <000701c00fb4$8ccf4e20$3150073e@ji1l6>, Adrian Fogarty
> <[log in to unmask]> writes
> >I agree with Stephen; falls are very high risk, and small falls can be
> >riskier because they are often overlooked.
>
> Which is the reason, I presume, why lots of X-ray guidelines don't
> include injury mechanism, because when we get to see the patients we
> haven't seen the accident, and make all sorts of assumptions about the
> "mechanism" of injury which may be completely wrong, thus safer to
> assume nothing about the mechanism.
>
> The point is that the mechanism of injury to the SPINE is what forces go
> through the C-spine, not what go through the car/crash cage/seat or lack
> of these when coming off your horse/bike. We are not good at guessing
> the former from the latter.
>
> --
> Sam Waddy
> SHO Oxford (ex A&E and can't wait to get back one day!)
>
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