Is everyone using steroids (within 8 hours of injury) in those with spinal
fractures & spinal cord injury?
John Black
Oxford
-----Original Message-----
From: Dunn Matthew Dr. (RJC) ACCIDENT & EMERGENCY - SwarkHosp-TR
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Sent: 08 May 2003 09:55
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Subject: Re: pre-hospital spinal control
> In other words, paralysis following RTA with extrication is
> highly likely to
> have occurred as a result of the RTA, not the extrication. If
> the energy of
> the accident was sufficient to fracture the vertebrae and rupture the
> interspinous ligaments, it's hardly going to be insufficient
> to damage the,
> now unsupported, spinal cord. And the test in civil law relies on the
> balance of probabilities, so as long as the former is more
> likely than the
> latter (>50%) then a court will find in favour of the former scenario.
I can imagine a scenario in which a spinal cord could be compressed by
fragments from a burst fracture and further movement would cause additional
damage- and certainly additional swelling with damage to the blood supply.
Analogous to long bone fractures where movement after the fracture can cause
additional soft tissue injury (and indeed the pain which suggests release of
inflammatory mediators likely to cause swelling).
If you have good documentation that paralysis was present prior to
extrication (and doing a full neuro exam prior to extrication is not good
practice) you'd have a defence, but otherwise I reckon you could find
yourself up against a spinal surgeon (who would tend to carry more weight
than one of us as a causation expert) who could convince the court of the
above scenario.
If caught in that situation, I'd probably rely on a Bolam defence on the
basis that not stabilising the spine was an accepted practice. There
certainly is a reasonable body of (if a minority) opinion that holds that
rapid extrication to care for suspected life threatening injuries takes
priority over spinal cord control with the methods generally available.
Matt Dunn
Warwick
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