“
“Background: The Canadian cervical spine rule (CCS) has been found to be an effective tool to determine the need for radiographic evaluation of the cervical spine (c-spine) incorporating both clinical findings and mechanism. Previously, it has been validated only through clinical follow-up or selective use of X-rays. The purpose of this study was to validate it using computed tomography (CT) as the gold standard HM781-36B chemical structure to identify fractures.

Methods: Prospective evaluation was performed on 3,201 blunt trauma patients who were screened by CCS

and were compared with a complete c-spine CT. CSS positive indicated at least one positive clinical or mechanism

check details finding, whereas CT positive indicated presence of a fracture.

Results: There were 192 patients with c-spine fractures versus 3,009 without fracture on CT. The fracture group was older (42.7 +/- 19.0 years vs. 37.8 +/- 17.5 years, p = 0.0006), had a lower Glasgow Coma Scale score (13.8 +/- 4.2 vs. 14.4 +/- 4.3, p < 0.0001), and lower systolic blood pressure (133.3 +/- 23.8 mm Hg vs. 139.5 +/- 23.1 mm Hg, p = 0.0023). The sensitivity of CCS was 100% (192/192), specificity was 0.60% (18/3009), positive predictive value was 6.03% (192/3183), and negative predictive value was 100% (18/18). Logistic regression identified only 8 of the VS-6063 19 factors included in the CCS to be independent predictors of c-spine fracture.

Conclusions: CCS is very sensitive but not very specific to determine the need for radiographic evaluation

after blunt trauma. Based on this study, the rule should be streamlined to improve specificity while maintaining sensitivity.”
“Anesthesiologists commonly use opioids for pain control in the operating room and postanesthesia care unit, and are constantly vigilant in looking for possible adverse outcomes. Therefore, common complications such as nausea, vomiting, and pruritus are well known. However, neurologic complications after opioid administration are relatively rare except for reduced consciousness, for example drowsiness or sedation. We recently experienced a case in which a 73-year-old woman presented predominantly vertical nystagmus as a neurological complication after epidural administration of fentanyl. A few previous reports on opioids as causative agents for nystagmus have all after use of epidural morphine, and there are yet no publications reporting epidural fentanyl as the cause of nystagmus. Physicians should keep in mind that epidural fentanyl could cause the nystagmus as a neurological complication even though it is used within conventional dosage ranges, although this is very rare.