Posted by: medicblog999 | June 22, 2009

What would you have done – The conclusion

x-ray_20cerv_20lat_20djd2If you haven’t already done so, click here to read the start of this story.

My decision, goes along with all of yours, so I guess I was right.

He was up and about and running all over the place, so I asked the police officer who was with him to direct him over to the back of my car and asked him to sit on the edge of my cars boot (or trunk for you Americans!). I specifically didn’t put him in the car because I too had visions of one of my colleagues arriving and saying, right….roof off!!.

Once he was in that position, I placed a cervical collar on him and informed him of my plan – to get an ambulance down to the scene and place him on a spinal board for the short journey up to A&E for his neck to be cleared by the docs.

The fact that I didn’t really believe him, as far as the location and quality of the pain, was irrelevant. He stated that he had central neck pain, so from that moment on, he was always going to be boarded and collared.

We waited approximately 20 minutes for the ambulance to arrive and during that time, he became restless and stated that he wasnt going to go to the hospital, as he wanted to sort out what was happening with his family and the others involved in the incident. I again informed him of my concerns that he may have a spinal injury but he still refused to go to hospital.

So, out comes my little speech:

“I know you don’t want to go to hospital, but you have to understand that you have had quite a beating and you don’t know what has been done to you whilst you were unconscious on the floor. You are telling me you have central neck pain, and that causes me to be concerned about you spine and spinal cord. I am strongly advising you to go to hospital but I cannot force you. However, if you continue to refuse my help, then I will remove the collar after you have signed this form, which states that you are acting against my advice and therefore if you go off home tonight and wake up in the morning unable to move your arms and legs, its all down to you, not me. Do you understand?”

That changed his mind, and he agreed to wait and be seen up at the hospital.

The crew arrived and we moved him onto the spinal board and he was transported up to A&E. I don’t know the outcome of his assessment at the hospital, but I am confident all was well (I hope).

I do not take risks with neck pain. If they say they have it and it is central, then they are getting boarded and collared, no question!

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Responses

  1. NOT QUITE THE SAME BUT 4/5 YEARS AGO TREATED A MOTOCROSSER COMPLAINING OF FOOT PAIN.NO SIGN/SYMPTOMS OF SHOCK COULD MOVE ANKLE KNEE HIP.NOTHING VISIBLE ON FOOT/ANKLE.
    DECIDED ON A QUICK TOP TO TOE JUST TO BE CERTAIN NO OTHER PROBLEMS.
    BIG LUMP MID THIGH!!!
    SPLINT AND HOSPITAL ASAP
    FRACTURE MID SHAFT PINNED THAT NIGHT
    GO WITH YOUR INSTINCTS

  2. Yeah I would definitely agree with you. Although similar patients have walked in to A&E (head injury, central neck pain), so we have dutifully put them in collars and head blocks on their trolley, only to be told by the consultant to ‘take it all off, they’ve been walking around with it, they’ll be fine’. One of these days someone might just actually have a fractured C-spine that has walked into our department… ah well… as long as I do my job right 🙂

  3. I would agree with this. Once at the hospital, the docs may decide to get him up and mobilise, but that is their decision, in a hospital, after a period of rest, rather than at the roadside. Sure, it adds to the workload of the Ambulance Service, but, as you have said, you like your job…


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