It's 2:30 AM and the bars have just closed. EMS brings an uncooperative, intoxicated 40-year-old male to your emergency department who was the driver of a vehicle that ran into a house. He has no complaints other than the need to urinate, and he wants the cervical collar off. He is verbally abusive, refuses to lie still on the backboard, is trying to take his collar off, and wants to leave. The nurse hands you an AMA form then wonders aloud why you are ordering a cervical spine film on a patient with no complaints; she also wonders how you plan to keep the patient still while he waits for the study.
Despite repeated attempts at verbal reassurance, soft restraints, and benzodiazepine sedation, the patient remained uncooperative with his ED evaluation. He was intubated so as to protect him from self-harm until his imaging was completed. His cervical spine CT revealed a burst fracture at C6 with retropulsion of bone fragments into the spinal canal.
Lisa Freeman Grossheim; Kevin Polglaze; Rory Smith
April 2, 2009