>In my department guidelines agreed jointly with the orthopaedic departmnt we
suggest that in patients with neck pain but no neurological signs, that if there
is difficulty obtaining an adequate lateral film after two attempts at traction
on the arms that we move to trauma obliques. We also suggest that at this stage
that it might be appropriate to sit the patient up and left gravity help.  This
is a decision that needs to be made taking in account the possibility of other
injuries.
Frank O'Dwyer, A&E Consultant  Burton upon Trent.

 As a radiographer, I came across a regular problem in our department. A chap

>had fallen through a roof and fallen 20 feet. He'd injured his shoulder and

>had pain in his lower back. He didn't have C-spine tenderness, yet (due to

>the mechanism of injury) we needed to clear his C-spine first. So our
>imaging priority was his C-spine, Lateral view.
>He was a large chap and had bulky shoulders, lying on a spinal board, hard

>collar in situ( an imaging nightmare!). Due to his shoulder injury, the Cas

>SHO said it would be impossible to apply traction to that side. So we tried

>everything we could think of, (5 radiographers with over 30 years experience

>between us) traction, swimmers, variations of the two,  and we had to resort

>to trauma obliques to show the alignment of C7/ T1 (which our SHO was not
>confident about interpreting).
>One of our number mentioned it would be so much easier if we could just sit

>him up, and let gravity assist us.
>Now, clearly in this case with the patients lower back pain it would not be

>suitable, but I was wondering why we couldn't sit patients up if they had no

>back pain?
> We were only attempting to x-ray this chaps neck because of his mechanism

>of injury, and occasionally these patients come for imaging attatched to
>spinal boards and/or headblocks with no neck/back  pain, (except that one
>they're getting from lying on the spinal board for so long!).
>Are there guidelines regarding when patients should be immobilised flat on
a
>trolley, or could they be sat up to some degree to facilitate better quality

>images?
>While I'm on the issue, I thought spinal boards were an extrication device-

>they look very uncomfortable and often a patient can have spent over an hour

>on them before we've finished x-raying everything we've been asked for. I
>asked a Casualty nurse about it, and was unhelpfully informed that the
>patient couldn't be removed from the spinal board and clothing couldn't be

>cut off until we'd cleared the spine. Somehow that doesn't match with my
>experience, and I would be grateful for some clarification from the 'docs'.

>As a radiographer I would ideally like to provide the best quality images
>possible- and the information I have been given by the A and E staff I work

>with seems confusing at times and conflicting at worst!
>TIA
>Vikki Chase
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