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I completed my medical school and background EM training from India (Christian Medical College, Vellore and Apollo Hospitals, Hyderabad) where I worked for 4 years. Following this, I devoted (with all my heart) about 1.5 years to do US Medical Licensing Exams. My stint towards an EM Residency in States did not work but it took me to places and it has been quite a journey. I then relocated to London, England to work as a Registrar (Non-Trainee) in A&E. This gave me an opportunity to better understand NHS, EM training pathways and more importantly the EM Mindsets in the United Kingdom. 

Currently, I am pursuing Higher Specialist Training in Emergency Medicine at South East Scotland Deanery where I have the honour and privilege of training under some of the most innovative brains in the field of Emergency Medicine. Over the past few years, I have realised that LEARNING and UNLEARNING (which can be challenging!) is equally important to deliver cutting edge care to our patients.And through this blog, I aspire to disseminate knowledge, assist trainees with exams and stay up to date with contemporary EM literature. I have always been an avid FOAMed supporter because FOAMed has always played an indispensable role during my training. 

Lakshay Chanana
ST4 EM Trainee 
Edinburgh, Scotland

Monday, January 16, 2017

The obsolete C-Spine X-Rays - Part 2

AP View (Peg view)

The stability of C1-2 depends mainly on the transverse ligament. When looking at peg view, watch out for these three things:

1. Vertical Alignment of lateral margins of C1 and C2 (Vertical white lines in the image below) - If there is vertical misalignment of the masses then consider four possibilities - ligament injury, burst fracture of C1 (Jefferson #), rotation or developmental variation.

Slight neck rotation can often lead to unequal appearing spaces on either side but if this is the case, then lateral masses of C1 and C2 remain normally aligned.

2. Spaces on both sides of Peg should be approximately equal (Horizontal white lines in the image below) - Normal distance between peg and the lateral masses on each side is between 3-5mm.

Laterally displaced lateral masses (Jefferson #))

Rotated film leading to unequal distance on one side of peg

3. Look if there is a fracture on the base of the peg

Peg fracture

Beware of the Mach effect - an optical illusion which appears like a fracture through the base of peg.

Make a note of the horizontal black line crossing the base of peg - MACH EFFECT

Images taken from:


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