A few comments:
At 11:38 PM 27/3/96 -0500, James Chamberlain wrote:
>THhree common myths, that are dying hard...hmmm
>1) Everyone who arrives with a C-collar in place needs Xrays to
>"clear" the spine.
Nothing clears the c spine. X-rays are only contribute when they show an
abnormality that will change your management - Like call an experienced
>2) Everyone with a brief loss of consciousness, despite a normal neuro
>exam, needs a CT scan.
Had an 18 y old with < 5 min amnesia and witnessed to never lose
consciousness. Large extradural, no neuro signs, one operation, no problem
afterwards. We CT all patients with amnesia no matter how brief. If you have
a CT and don't use it - good luck to you when you miss one. Just calculate
the cost of a single law suit against the cost of scanning. Our prospective
review shows that one in 300 of minor head injuries with GCS 15 have an
operation on the basis of the scan alone.
>3) Everyone with a seriuos mechanism of injury, regardless of their
>physiology, needs admission for observation (or needs a stay in the
>observation unit for 12 or 24 hours, depending on your local custom).
Three patients in the last four months have been kept for this reason and
developed frank peritonitis between 12 and 24 hours despite no abdo
abnormality on arrival.
>4. Only a surgeon can accurately diagnose appendicitis.
Who else takes it out and makes the diagnosis. Everyone else only suspects
it with a provisional diagnosis. In fact, the pathologist is the real final
>5. Only a surgeon can accurately rule out occult intraabdominal injury.
Have you been having territorial problems with our surgical collegues?
>6. A neurologist needs to consult on every child with a simple febrile
>7. A child with a simple febrile seizure needs lytes, calcium, magnesium,
Does anyone with a first seizure need these. The literature doesn't support it.
>8. A child with an afebrile seizure needs an immediate CT scan and LP.
>9. A patient with low risk of disease needs a test for "medicolegal
>reasons," whatever that means.
Agreed. We are doctors. The safest 'medicolegal' practice is to do
everything and only those things which you believe are medically indicated.
>10. All adolescents with chest pain should have an ECG and Chest Xray.
Youngest infarct I have personally seen was 18 direct from the football field.
>11. Physicians can predict which children are bacteremic.
>12. Most physicians can diagnose otits media accurately in infants.
>13. The ED is the best place to treat patients with psychiatric disease
>and victims of sexual assault.
It is until the public knows they have a safe, easily accessed and reliable
>14. The white blood cell differential is useful in distinguishing
>bacterial from viral disease.
>15. A chest Xray is often useful in infants with bronchiolitis.
>16 ED physician judgement and performance of skills is as good after 10
>hours as at the beginning of a shift...as good at night as during daytime...
>17. I'll still be able to work nights when I'm 50...
>18. My family life doesn't suffer when I work nights.
You sound very tired. Take two of these, have a large glass of milk, a good
sleep and consult your doctor in the morning if you don't feel better. ;-)
Garry (also feeling very tired)
Dr Garry Wilkes MBBS FACEM
Department of Emergency Medicine
Royal Brisbane Hospital
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