Unstable SCI, can they move arms in CT?

[Bjorn, Pret]

I'm unsure if there are any PRCT's specific to your need.  It's
doubtful.

 

But speaking from our experience moving all four patient extremities
pretty much ad lib throughout the acute care phase, we have yet to
observe an iatrogenic injury.  This comprises easily hundreds of
variously spine- and cord-injured patients at every anatomic and
severity level.

 

Indeed, what you will find with any combination of keyword searches in
PubMed is an utter vacancy of significant provider-related cord injuries
among patients with suspected spinal instability.  By exclusion, the
literature rather emphatically suggests that vigilance and prudence are
sufficient safety maneuvers, independent of specific immobilization and
transport strategies.

 

The only significant paralysis is that of the patient care process,
imparted by providers who take urban mythology and cadaver studies too
seriously.  Your hospital is one case study among many.

 

Best of luck.

 

Pret Bjorn, RN 

Bangor, ME USA

 

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of
johan.malmgren at vgregion.se
Sent: Sunday, September 02, 2007 5:16 AM
To: trauma-list at trauma.org
Subject: Unstable SCI, can they move arms in CT?

 

Everytime we have a patient with suspected spinal cord injury there's a
discussion when doing the initial trauma-CT about mobilization of the
arms. To get the best possible CT pictures the CT tech wants the patient
to have his/her arms above head (well, above in the direction of
continuing the bed :) ), and it is up to the traumaleader's approval to
arrange this. The patients are on spine board and with stiff neck
collar.

 

Now, we're having a meeting in a few days about problems concerning
trauma patients in the xray dept (why are they there if unstable etc
etc), and it turns out that our spinal cord dept wants to send a nurse
or physiotherapist on every suspected SCI-trauma to be the one giving
approval for arm movement. Personally I think we're too crowded as it
is. 

 

My question for the group is: Has there been any well performed studies
of what actually happens with an unstable SCI when doing these
manouvres? What are your local traditions with this? I would like to
attend this meeting with some good science in my back pocket! :)

 

 

Johan Malmgren 
Resident, Anaesthesia, Critical Care & Traumatology
Dept of Anaesthesia and Critical Care
Sahlgrenska University Hospital
Gothenburg, Sweden
+46313428073 [Work]
+46707696961 [Mobile]