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The most common car crash errors missed by the ER Doctors and staff that may cost you quality of life, and hundreds of thousands of dollars, $150,000-$550,000.

Stacked Evidence

Car crashes are significantly dangerous, especially at low speeds.  The year 2020 is upon us, the rightful time of engineers and phD physicists, crash reconstructionists, and medical doctors and chiropractic physicians specializing in spinal injuries have thoroughly reviewed the best evidence and literature to date, along with personal injury attorneys.  There is an abundance of highly reproducible, and very well performed literature and research that demonstrates a clear lack of correlation between low speed car crashes, and minimal injury.  In other words, it is not true that if your crash occurs at a low speed, that your injury is less severe.  In fact, the opposite has been proven.

The reality is, if your car doesn’t take the damage, guess who does?  You do; you absorb the damage.  Car crashes happen so quickly, your body literally doesn’t have the time to react and brace yourself for the massive damage that typically occurs with the car crash.  Our bodies simply do not “travel” at speeds greater than 10-20 mph, let alone 8-10mph for many.  Imagine yourself sprinting full speed.  A well-trained athlete can sprint approximately 10-14 mph.  Now imagine that athlete in a full out sprint.  Then immediately drop a wall in front of them.  Not a pretty sight, is it?  That is precisely the immediate stoppage that occurs in a car crash, except the worse problem is that your whole body is stopped (due to the seat and lap belt), but the rest of your upper neck continue to propel forward, as if it’s not attached to your body.  Not a pretty sight.

The Body’s Delicate Nerve System

In fact, your cervical spine (the neck) absorbs a lot of the damage.  The cervical spine is also the most delicate area of your spine, as it protects and houses the brainstem.  The same area Christopher Reeve’s, aka Superman, damaged when he fell off his horse and became a quadriplegic.    It’s similar to having a carton of eggs.  If you drop the carton of eggs, what happens to the actual carton?   Not much damage right?  What about the eggs inside?  When you go to buy a carton of eggs, you don’t just look at the carton to tell if the eggs are cracked or still whole, you open the carton.  The same applies with your spine.  We need special imaging, MRIs or radiographs (x-rays) to determine the true severity of injury.

If I’m Not Dead, I’m Not Hurt.

Sometimes, we’re fooled into thinking that if we can walk away, we’re not damaged.  On the contrary, after successfully studying, observing and treating several thousands of patients with spinal damages, we’re grossly misled and misinformed.  After interviewing patients and analyzing their special imaging, and physical examination findings along with symptoms after car crashes, I often ask the patients, especially those involved in low speed crashes, “why do you think that you ‘weren’t hurt’ in the crash?”   Their answer often comes down to the ideology that if they don’t see an arm severed off, bleeding, bones sticking through the skin, are knocked unconscious, or worse, are left paralyzed, that they are not injured.

Reality Check.

Due to the above severity of injury, it’s important to perform a a complete and thorough analysis of the Spine after a car crash, regardless if you “think” you’re healthy.  The medical literature is clear.  Over 18% of patients with one spinal neck injury alone, had no complaints of neck pain; injuries may be subtle, though severe, and therefore they aren’t imaged, and subsequently not found.   Medical research demonstrates that clinicians inability to accurately predict injury after crash based on their assessment alone.  The apprehension is supported by research substantiating the superiority of x-rays over clinical assessment in clearing the spine of damages.

In our practice, we don’t guess with your health.  When complete exams are not performed, issues are missed. Ultimately most ERs do not take x-rays of the cervical spine.  Even when they do, often times they’re performed lying down, which is inconclusive for the expert spine physician.  When radiographs show abnormal alignment, fracture, degeneration, translations and/or congenital abnormalities affecting alignment, there is often much that can be done to correct, treat and prevent the spine from having future issues.

The Critical Missing X-Factor

How do you know when to have x-rays done in the ER?  And what is the one finding most commonly missed in E.R.s?    This one finding, when missed, may prove disastrous to your future treatment and ability to correct and fully heal.  That finding is the correctly performed physical spinal exam.  This exam must include range of motion (active) and palpatory tenderness.  E.R. doctors and staff often forget, or omit, palpation of the neck for presence of tenderness and pain, along with full and complete voluntary (active) neck range of motion: bending forward and backwards, side to side (ear to ear) and full head rotation to both sides.

They’re not entirely to blame however.  When it comes to ‘improper’ exams and assessments, physicians are taught that to follow symptoms from the patient.  However, after a crash, your endorphins are at an alltime high, and often dilute or completely mask pain, and many other serious injuries.  In fact, if a physician is not an expert in car crashes and spinal injuries,  they are going to miss things.   If range of motion is not assessed voluntarily (meaning you the patient performs the movement), then you can’t rule out taking x-rays.  Often times ER doctors may skip palpating (touching to evaluate) your neck, in an effort to save time because more deadly conditions are walking through their doors.  They may perform ranges of motion by grabbing your head and putting you through the ranges of motion, however both active and passive ranges of motion must be performed.

Get Help.

Check out our clinic today if you were involved in a car crash recently.  Or, if you were ever involved in a crash, and did not have a full set of spinal x-rays performed, it is likely that your trip to the ER (or worse, you didn’t have any examination performed), was incomplete and left you in worse condition.  Many symptoms after a car crash are headaches, nausea, mood changes, loss of smell and or memory,  chronic neck pain, fatigue and energy level drops, poor digestion, inability to focus and concentrate, difficulty going to the bathroom, inability to concentrate at work, posture problems.  These are just a few that are most commonly overlooked after a crash.

Resources:

Jacobs LM, Schwartz R. Prospective analysis of acute cervical spine injury: a methodology to predict injury. Ann Emerg Med 1986;15:44-9.

Ransohoff J, Fleischer A. Head injuries. JAMA 1975;234:861-4.

Bresler MJ, Rich GH. Occult cervical spine fracture in an ambulatory patient. Ann Emerg Med 1982;11:440-2.

Maull K, Sachatello C. Avoiding a pitfall in resuscitation: the painless cervical fracture. South Med J 1977;70:477-8.

Williams CF, Bernstein TW, Jelenko C. Essentiality of the lateral cervical spine radiograph. Ann Emerg Med 1981;10:198-204.

Walter J, Doris PE, Shaffer MA. Clinical presentation of patients with acute cervical spine injury. Ann Emerg Med 1984;13:512-5.