Clearing the cervical spine after polytrauma: implementing unified management for unconscious victims in the intensive care unit.
Determining the best method for excluding cervical spine injury while a polytrauma victim is unconscious remains a controversial topic despite a number of published guidelines. A structured questionnaire demonstrated major differences between intensivists, neurosurgeons, orthopaedic surgeons and spinal surgeons with regard to the imaging modalities requested, the perception of their performance, the relative risks of missed injuries and the complications of immobilisation. Unconscious victims of polytrauma often come under the care of several subspecialties, with the direct consequence that management can be contradictory and lack standardisation. Advanced Trauma Life Support and Eastern Association for the Surgery of Trauma guidelines can reinforce and even contribute to non-standardised care. Having performed this clinician survey, we have now developed a multidisciplinary management protocol appropriate for Northern Ireland.
Morris
C G
CG
Department of Intensive Care Medical and Anaesthesia, Regional Intensive Care Unit, Royal Victoria Hospital, Belfast, BT1 26BA, Northern Ireland. cmorris@doctors.org.uk
Mullan
B
B
D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D003422:Critical Care / Q000379:methods / Q000592:standards*; D005471:Fluoroscopy; D019538:Health Care Surveys; D006801:Humans; D007103:Immobilization; D007442:Intubation, Intratracheal; D008279:Magnetic Resonance Imaging; D009104:Multiple Trauma / Q000000981:diagnostic imaging*; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011877:Radionuclide Imaging; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed; D014474:Unconsciousness / Q000000981:diagnostic imaging* / Q000209:etiology