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Canadian C-Spine Rule: How To Know If A Neck Is Likely To Be Broken

Christian Vaillancourt, MD and his colleagues recently published an article in the journal Annals of Emergency Medicine (2009;54:663-671) entitled “The Out-of-Hospital Validation of the Canadian C-Spine Rule by Paramedics.” This rule was originally developed for “clinical clearance” (e.g., without the use of x-rays) of persons with possible cervical spine fracture (broken neck) in alert and stable trauma patients by qualified persons (generally, emergency physicians) in a health care setting (such as an emergency department). This particular study found that paramedics can apply the Canadian C-Spine Rule reliably, without missing important cervical spine injuries.

The Rule, properly applied to an awake and alert injured person for which there is a concern for a cervical spine injury, provides the following direction:

1. If a person has a high-risk factor (age greater than or equal to 65 years; a dangerous mechanism of injury [a fall from an elevation greater than or equal to 3 feet; fall down 5 or more stairs; direct blow to top of head, such as a diving board accident; motor vehicle accident characterized by high speed, rollover or passenger ejection; motorized recreational vehicle accident; bicycle collision]; or numbness/tingling in an arm or leg), then neck immobilization and x-rays are indicated. Read more »

This post, Canadian C-Spine Rule: How To Know If A Neck Is Likely To Be Broken, was originally published on by Paul Auerbach, M.D..

Listen to Your Psychiatrist, Uncle Sam

uncle-sam Dear Uncle Sam:

I know it’s been a rough week. I’m sure you’re grieving the lost of life at Fort Hood just like the rest of us, but I’m compelled to write you this letter. I hope you take it in the spirit in which it is meant.

I read an article at today that made me wonder about your judgement. Since when did you stop listening to your doctors? The article was about Dr. Kernan Manion, a psychiatrist who wanted to help troops before they went postal on military bases. Uncle Sam, Dr. Manion use to work for you at Camp Lejeune, North Carolina. Then he got fired. Why did you give Dr. Manion the boot for stating the obvious? He pointed out that troops at Camp Lejeune are getting bullied by superiors and dumped into an overwhelmed mental health care system when they asked for psychiatric help. Read more »

*This blog post was originally published at Nurse Ratched's Place*

How To Know If A Doctor Is Good – Ask A Nurse

In a comment on my last post, faithful reader and frequent commenter Anonymous asked, “How do you get a good reading on interpersonal skills in a brief interview?”

That’s a good question.  I suppose the simplest answer is, you don’t, at least not in any sort of comprehensive way.  In some cases you can — a person who is warm, engaging, and able to hold up their end of a lively conversation in an interview setting is always going to be near the top of my list.  But I make a lot of allowances for people in their interviews — they are nervous, know they are being watched and judged, it is a high-stakes encounter for them, and most people are a lot more constrained in an interview than they are in their day-to-day lives. Read more »

*This blog post was originally published at Movin' Meat*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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