August 2015 Introduction

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Nurses Edition Commentary

Mizuho Spangler, DO, Kathy Garvin, RN, and Lisa Chavez, RN
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Karl T., M.D. -

ok, so the intro talks a lot about getting an MRI after a normal CT of the c-spine. Didn't we just have a paper in the July issue that said MRI wasn't needed if CT was normal?

Anand S., M.D. -

Karl - thanks for bringing this up. Definitely a lot of room for confusion here.
The EAST trauma guidelines discussed in the July paper chase recommend consideration for clearing the C-spine after a negative non-contrast c-spine CT in obtunded trauma patients. I think this has been standard care for a lot of trauma guys for the last couple of years. The issue is that transporting obtunded patients to MRI is wrought with hazards and leaving a patient who is intubated + not moving around in a c-collar is bad for ICP and pressure sores.
In awake, neuro intact patients with negative CT c-spine but continued midline tenderness, the recommendation remains to either get flexion-extension films (not in the emergent setting, usually 1-2 weeks after injury) or an MRI or simply home in a c-collar for delayed re-evaluation.

Evan M., M.D. -

Rob- Are you sure you have the definitions correct in your Sepsis Decision pathway? It was my understanding that Severe Sepsis is lactate >2 (above laboratory normal) and that lactate >4 seems to represent a "worser" severe sepsis. Have a look at up to date and the NQF.

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