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In Georgia, what is the Standard of Care in Emergency Room Cases regarding the Premature Removal of the Backboard and Neck Brace ~ part two?

This is a continuation of my prior blog post pertaining to the Questions to be Asked and the Importance of Said Questions in determining the Standard of Care, or breach thereof, in the Emergency Room for the Premature Removal of the Backboard and the Neck Brace.

The fifth question to ask is whether or not a cervical spine radiograph (CSR) was or was not performed? This is important since a cervical spine radiograph is necessary for a comprehensive evaluation of the cervical spine (2009) 40 ESINJR 8 795-800.

The sixth question to ask is what were the results of the cervical spine radiography (CSR)? This is important since in all cases of suspected spinal column injury, immobilization of the spine needs to be maintained until an unstable injury is ruled out. If this is not done then there is a question of whether or not the standard of care was breached (2011) 91 ESRCNA 1 209.

The seventh question to ask is whether or not the consciousness of the patient was or was not assessed using the Glasgow coma scale? This is important since low-risk patients consist of awake, alert, cooperative and non-intoxicated patients without any distracting injury. These patients are given a 15 on the Glascow coma scale. With a detailed history and physical examination the cervical spine of patients in the "low-risk" group can be "cleared" without further radiographic examinations. Patients who are not low-risk, on the other hand, may not necessarily be cleared without further examinations and if a higher-risk patient was prematurely removed from the neck or back brace, then there is an indication of a breach of the standard of care (2009) 40 ESINJR 8 795-800.

The eighth question to ask is whether or not the clinician obtained a neurological consultation? This is important since early consultation with a spine or neurosurgeon is critical for identification and optimal management of cervical spine injuries. If a specialist is not consulted in the early stages, then there is an indication of a breach of the standard of care.

The ninth question to ask is whether or not the patient regained consciousness? This is important since a disproportionate number of cervical spine injuries are associated with moderate and severe head injuries sustained in motor vehicle crashes. Head-injured patients are almost four times as likely to have a cervical spine injury as those without head injuries and many of these patients are unconscious upon evaluation. As stated herein above, it is very important to treat the unconscious patient is a different manner than the conscious patient.

The tenth question to ask is whether or not a drug screen and blood alcohol level was or was not obtained? This is important since it is necessary to ascertain that the patient's symptoms are not the result of a drug they have induced or the effect of alcohol consumption. Patients who have ingested drugs or alcohol should be treated differently than those who have not ingested drugs or alcohol (2009) 40 ESINJR 8 795-800.

The eleventh question to ask is whether or not a CT scan performed? This is important since plain cervical spine radiographs are also an inefficient method of evaluation of the cervical spine after blunt trauma, and a more comprehensive radiograph or other test may need to be performed for a more comprehensive evaluation (2011) 91 ESRCNA 1 209-216.

The twelfth question to ask is whether or not a neurological examination performed? This is important since patients with an altered mental state are high-risk patients. Therefore, a neurological assessment needs to be performed to determine if you have a high-risk patient (2009) 40 ESINJR 8 795-800.

The thirteenth question is what was the CT scan result? This is important since some patients have neck pain without demonstrable injury on the CT scan. These patients may have significant ligamentous injury that requires further evaluation and treatment and it is important to note any injuries that may not have appeared on the CT scan (2011) 91 ESRCNA 1 209-216.

One of the final questions to ask is whether or not the collar was or was not removed? This is important since the cervical spine is considered cleared only if the patient is (1) awake, alert, oriented, and free of intoxication, (2) with normal neurologic examination, (3) without significant distracting pain or injury, (4) without pain with palpation of the cervical spine, including axial loading, and (5) without pain with full active range of motion of the neck, including flexion and extension. Without these signs being present and the collar has been removed then there is a possible indication of a breach of the standard of care (2011) 91 ESRCNA 1 209-216. If, however, all studies; the CT scan, the flexion extension radiographs and the MRI, are negative, the cervical collar may be discontinued (2011) 91 ESRCNA 1 209-216.

This is not meant to be an exhaustive list of questions that should be asked in these types of Emergency Room cases but are meant to be questions and explanations for those questions that the experienced Medical Malpractice Attorney should evaluate to determine if there has been a Breach of the Standard of Care. We are experts at evaluating these, and other, types of Emergency Room cases so if you or a loved one has been injured or killed by the negligent acts of ER personnel, then it is important that you Contact Us as early on as possible so that we may evaluate your case to determine whether or not the Standard of Care was Breached in the Emergency Room as it pertains to the potential premature Removal of the Backboard and Neck Brace, and whether or not a Medical Malpractice Case should be pursued as a result.

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