25 year old male.

You find him on the Observation Ward in the morning when you do the ward round. He was admitted in the night after a roll-over RTA in which the driver was killed. He may have been knocked out he has had his breakfast, brushed his teeth, and is keen to go home. His neck feels a bit sore. You go to review his Xrays but there are no C-spine films.

You read in the notes that the patient was "too combative to have X-rays taken".

He is not complaining of any parasthesia or weakness.

You examine him and note bony tenderness in the upper c-spine. He is reluctant to mov ehis neck any more than 20% of normal in any direction.

You refer him to radiology for a C-spine series.