Dr. Maureen Molloy: An 18-year-old healthy man fell headfirst a distance of about 12 ft into 2 ft of water. He was uncertain whether or not he lost consciousness, but from the time of the accident he was unable to move his right arm well. He was taken to a neighboring hospital where x-ray films showed a "dislocation of C-3 on C-4." An adjustable cervical collar was applied, and he was referred to the Massachusetts General Hospital for treatment.
On arrival in the emergency ward, approximately 8 hours after the injury, he was drowsy but could be aroused easily. His blood pressure was 130/80 mm Hg, his pulse 88 beats per minute, and his respirations 18 per minute. There was blood on both lips with a laceration of the midupper gum. His nostrils were crusted with blood.
The patient's chest was clear to percussion and auscultation. Both the diaphragm and intercostal