----- Original Message -----
From: "Rowley Cottingham"
> I don't think this differs too much from what I posted, except that I
regard chest X-ray (B for breathing) and the pelvic
> X-ray (C for circulation) as part of the Primary Survey. I don't give a
stuff about when the neck X-ray is performed
> provided the patient is adequately secured in the meantime, and if there
is a painful injury I'd rather give some analgesia and let that work a bit.
I quite agree, It makes sense to get x-rays done during the primary survey,
but it may not be that critical in many patients.
> You get enough from those two films. They are all you should be doing in
the resus room, although I will allow a cervical
> spine lateral, but the gotcha is that even a perfect and adequate film
will miss up to 15% of abnormalities. I have seen two patients who
exemplified this perfectly recently; one elderly who was hit by a car and
had a clinically inapparent #NOF and one young faller who had an equally
inapparent and very nasty vertical shear # of his pelvis.
Not sure I follow the logic of that last paragraph Rowley. Anyway a quick
question to the LIST; ATLS and others often quote that the sensitivitiy of
the lateral c-spine is around 85%. However this seems hugely at odds with my
personal experience. I suppose I look at 5 to 10 c-spine series a week,
several thousand over the last few years. And I don't think I've ever seen
an abnormality on the AP that was not visible on the lateral. Essentially I
believe the lateral c-spine film is incredibly sensitive and as a result I
often now rely solely on the lateral with clinical exam and judgement. Has
anyone else got this perception?
Adrian Fogarty
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