Cervical spine immobilization is a routine precaution taken by both EMS and Emergency Departments for patient who experience oftentimes minimal trauma. The purpose of maintaining immobilization of the cervical spine with suspected bony injury is to prevent secondary injury.
What is Spinal immobilization in trauma?
Spinal Immobilization in Trauma Patients. Background: It has been common practice in trauma to place patients in cervical collars and on long backboards (LBBs) to achieve spinal immobilization. LBBs are used to help prevent spinal movement and facilitate extrication of patients.
Does spinal immobilization work for cervical spine movement in prehospital ground transport?
Objective: This study aims to evaluate the efficacy of two different spinal immobilization techniques on cervical spine movement in a simulated prehospital ground transport setting. Methods: A counterbalanced crossover design was used to evaluate two different spinal immobilization techniques in a standardized environment.
What is the procedure for immobilizing the upper spine?
To outline the procedure for applying immobilizing the upper spine, including application of a cervical collar and “boarding” the patient. Application of a cervical collar and placing the patient on a backboard may be indicated for trauma patients with mechanisms of injury that place the patient at risk for spinal injury.
When is Spinal immobilization indicated in the evaluation of head injuries?
The need for spinal immobilization is determined when assessing the scene and patient. Consider spinal immobilization when the mechanism of injury creates a high index of suspicion for head or spinal injury. Altered mental status and neurologic deficit are also indicators that spinal immobilization should be considered. [1][2][3][4]
How do you immobilize C spine?
The traditional ATLS teaching for adequate spinal immobilization of a patient in a major trauma situation is a well fitted hard collar with blocks and tape to secure the cervical spine in addition to a backboard to protect the rest of the spine. other devices currently in use are scoop stretcher and vacuum splint.
What is C spine protection?
Cervical spine protection is indicated in the following trauma settings: Neck pain or neurological symptoms (OR58 for focal neurological deficit) Altered level of consciousness (OR14 for decreased level of consciousness) Significant blunt injury above the level of the clavicles (OR8.
When do you immobilize C-spine?
Prior to ruling out injury, to minimize further risk of damage, complete spinal immobilization has been recommended. In the context of a suspected cervical spine injury, patients are immobilized in a “neutral position” based on the head and trunk resting on a flat surface (10,11).
When do you apply C-spine?
When can the Canadian C-Spine Rule be Applied?Trauma was experienced.The patient must have a Glasgow Coma Scale (GCS) of 15 (they are alert)All vital signs are stable.The patient is 16 years and older.There is no acute paralysis.There is no known vertebral disease.More items...•
How do you maintain C spine precautions?
One person is assigned to maintain manual control of the cervical spine; 2 persons will be positioned unilaterally of the torso to turn the patient towards them while preventing segmental rotation, flexion, extension, and/or lateral bending of the chest or abdomen during transfer of the patient.
How can I protect my cervical spine?
Simple Tips for Protecting Your Neck from InjuriesPractice healthy sleeping habits. Sleep with a cervical, or orthopedic pillow, which is contoured to support the spaces under the head and neck. ... Be good to your neck at work. ... Consider the load you carry. ... Mind your posture.
How do you protect someone's cervical spine during intubation?
[31,32] In immobilized patients, especially for emergent intubations, direct laryngoscopy with the use of a gum elastic bougie is an excellent choice to quickly and reliably secure the airway while minimizing the force to the cervical spine.
What does C4 C5 C6/C7 control?
C5, as mentioned earlier, along with C3 and C4, contributes to the phrenic nerve that innervates the diaphragm. Roots C5, C6, and C7 produce the long thoracic nerve, responsible for controlling the serratus anterior.
What is the mean movement of the cervca spine?
Results Contro led se f-extrication without a co ar resulted in a mean movement of 13 330 from the neutral in-line position of the cervca spine compared to a mean movement of 18.840 during one of the equipment-aided extrications. Two equipment-aided techniques had significantly h'gher movement (pa 05) than other techniques. Both height (p=0 003) and mass (p=0.C2) of the participants were significant independent predictors of movement. Conclusions These data support the findings of the proof of concept study, for haemodynam cally stable patients contro ed self-extrication causes ess movement of the cerv cal spine than extrications performed using traditional prehospital rescue equipment. O OPEN ACCESS Confirmation of suboptimal protocols in spinal immobilisation? Mark Dixon) Joseph O'Halloran,2'3 Ailish Hannigan,4 Scott Keenan, Niamh M Cummins
Why are younger children more likely to have SCIS?
Younger children have more high-level injuries, fewer fractures, more dislocations, and more SCIS because of their larger head/body ratio, greater ligament laxity, and more horizontal facet joints . Outcomes are often poorer in younger than CSI in pediatric blunt trauma victims is rare and occurs in ap- 189— 194 proximately 1—2% of patients, although more frequent with Specific Pediatric Concerns Prehospital Use of Cervical Collars in Trauma Patients: Terje Sundstrørn,l A Critical Review Helge Asbjørnsen, Samer Habiba,3 Geir Arne Sunde, 2,3 and Knut Wester
What causes death in cervical trauma?
Vascular and airway injuries complicating penetrating cervical trauma require emergency intervention. Vascular injury compli- cates over 25% of penetrating cervical trauma with an associated 5.12.14.1720 Exsanguination was reported as mortality of up to 50%. the cause of 50% of penetrating cervical trauma deaths20 and is the leading cause of death in patients with penetrating cervical 14.16 Airway injury occurs in approximately 10—18% of trauma. patients with penetrating cervical trauma. The rapid mortality associated with vascular and respiratory tract injuries has lead many authors to stress the importance immediately treating these life-threatening injuries before addressing concerns about cervical 8.21012.15.19 spine instability. Increased mortality with delayed Increased risk of death with cervical spine immobilisation in penetrating cervical trauma Wesley B. Vanderlan , Beverly E. Tew, Norman E. McSwain Jr. Department Of Surgry, Tulane University, New Orleans, LA, United States
When to use manual in line stabilization?
strong recommendations. It is prudent for clinicians to use manual in-line stabilization when it does not hinder intubation attempts. There are data to support allowing some flexion and extension of the upper cervical spine if needed to facilitate visualization of glottic structures during direct laryngoscopy. AIRWAY/REVIEW ARTICLE Manual In-Line Stabilization for Acute Airway Management of Suspected Cervical Spine Injury: Historical Review and Current Questions
Is ballistic trauma to the neck a high mortality rate?
Our da suggests that it is very unlikely that penetrating ballistic trauma to the neck will result in an unstable cervical spine in survivors . In a hazardous environment (e.g. shooting incidents or terrorist bombings), the risk/benefit ratio of mandatory spinal immobilisation is unfavourable and may place medical teams at prolonged risk. In addition cervical collars may hide potential life-threatening conditions. Learning the lessons from conflict: Pre-hospital cervical spine stabilisation following ballistic neck trauma Arul Ramasamya' , Mark Midwinter a, Peter Mahoney a' , Jon Claspera aAcademic Department Of Military Surgery and Tmuma, Royal Centre for Defence Medicine, Birmingham, UK b Academic Department Of Military Anaesthesia and Critical Carp, Royal Centre for Defence Medicine. Birmingham, UK
Is CSI unstable after neck injury?
CONCLUSIONS The incidence of unstable CSI after penetrating trauma to the neck is exceedingly low at 040/0. No unstable CSI was observed after SWs to the neck. After GSW to the neck, unstable CSI was noted in of patients, all of whom experienced severe neurologic findings or altered mental status. Surgical stabilization of the spinal fracture was 1Mfonmed in only two patients (0.2%) without significant neurologic recovery. Unstable Cervical Spine Fracture After Penetrating Neck Injury: A Rare Entity in an Analysis of 1 ,069 Patients Thomas Lustenberger, MD, Peep Talving MD, PhD, FACS, Lydia Lam, MD, Leslie Kobayashi, MD, Kenji Inaha, MD, FACS, David Plurad, MD, FACS, Bernardino C. Branco, MD, and Demetrios Demetriades, MD, PhD, FACS
Is cervical spine immobilization effective?
Cervical spine immobilizatlon devices are effective but can result in patlent morbidity. Spinal immobilization devlces should be used to achleve the goals of spinal stability for safe extricatlon and transport. They should be removed as soon as a definitlve evaluation is accomplished and/or definitlve management is initlated. Spinal immobilization of trauma patlents WIth penetrat- Ing injunes is not recommended. Prehospital Cervical Spinal Immobilization After Trauma KEY WORDS: EMS clinical protocol, Potential spinal injury, Rigid cervical collar, Spinal immobilization Neurosurgery 72:22—34, 2013 DOI: 10.1227/NEu.0b013e31827&db1 www.neurosurgery-online.com
Why are cervical collars used?
Cervical collars (C-Collars) are used to help prevent movement of the cervical spine and often are combined with lateral head blocks and straps. The theory behind this is that spine immobilization prevents secondary spinal cord injury during extrication, transport, and evaluation of trauma patients by minimizing movement.
How long does it take for an ICP to be recorded after a collar reapplication?
Following collar reapplication mean ICP measurements were recorded after 3 and 5 minutes, at which time the collar was removed immediately
Why do people wear cervical collars?
Cervical collars (C-Collars) are used to help prevent movement of the cervical spine and often are combined with lateral head blocks and straps. The theory behind this is that spine immobilization prevents secondary spinal cord injury during extrication, transport, and evaluation of trauma patients by minimizing movement. Most of this information has been passed on from historical teachings, like the Advanced Trauma Life Support (ATLS) courses, and not from scientific research. To date there has been no high-quality evidence that use of spinal immobilization improves patient outcomes. In this post, we will review the evidence associated with spinal immobilization in trauma patients.
Does immobilization of vacuum mattress affect long term effects?
Long-term effects of immobilization of vacuum mattress alone not studied
Is there a correlation between collar application and neurologic outcomes?
No correlation between collar application and neurologic outcomes made in this study
Does ICP increase with cervical collar?
The extent of ICP increase can vary depending on the type of cervical collar used
Where is the Velcro tab on a cervical collar?
Adjustable rigid cervical collars are measured from the bottom edge of the rigid plastic to the red circle denoting the size of the collar (red circle will move up or down as size of the collar is adjusted) Slide the back of the collar behind the right side of the neck until the Velcro tab is visible on the left side of the neck.
What is the purpose of cervical collar?
Purpose: To outline the procedure for applying immobilizing the upper spine, including application of a cervical collar and “boarding” the patient. Policy: Application of a cervical collar and placing the patient on a backboard may be indicated for trauma patients with mechanisms of injury that place the patient at risk for spinal injury.
When is spinal immobilization needed?
The need for spinal immobilization is determined when assessing the scene and patient. Consider spinal immobilization when the mechanism of injury creates a high index of suspicion for head or spinal injury. Altered mental status and neurologic deficit are also indicators that spinal immobilization should be considered. [1][2][3][4]
What is block in spinal mobilization?
Blocks have been part of the inline mobilization strategy for stabilization of the spine it seems to be effective when strapping the patient on a spinal board of achieving a degree of immobilization with no added benefit of using the hard collar in conjunction [21]
Does spinal immobilization cause neck pain?
Finally, spinal immobilization has been associated with back pain, neck pain, and making it very difficult to perform some procedures including imaging. Spinal immobilization has also been associated with respiratory difficulties, especially when large straps are applied across the chest.
Is a spinal longboard good for spinal injuries?
The original spinal longboard has been used in conjunction with the hard collar, blocks, and straps to achieve immobilization of the spine. There is currently evidence of the potential harm especially pressure sores over the sacrum[19][20] This particularly true in the case of spinal injury with no protective sensation. The soft vacuum mattress offers a more gentle surface which protects from the effects of pressure sores while at the same time offers enough support if extended above the level of the head[16]
Is there a spinal restriction for trauma?
The 10 edition of the ATLS guidelines and the consensus statement of the American College of Emergency Physicians (ACEP), American College of Surgeons Committee on Trauma (ACS-COT), National Association of EMS Physicians (NAEMSP) states that in the situation of penetrating trauma, there is no indication for spinal movement restriction[6] this in keeping with a retrospective study of the American trauma data bank showed a very low number of unstable spinal injuries needing surgery in the context of penetrating trauma. The study further shows that the number needed to treat achieve potential benefit was much higher than the number needed to harm 1032/66. However, in the case of significant blunt trauma the restrictions continue to be indicated in the following situations:
Is altered limb neurology explained by limb trauma?
Altered limb neurology not explained by limb trauma
Is spinal immobilization universal?
While many EMS organizations have adopted these new guidelines on spinal immobilization, this is not universal. Some EMS systems fear litigation if they do not immobilize patients. Patients who should have spinal immobilization include the following:
Section 6 - TRAUMA
Background: This parameter is intended to provide personnel with a guideline for the selective exclusion from spinal restriction on patients who have a low index of suspicion mechanism of injury for spinal injury combined with a thorough assessment that supports the exclusion.
6.03 SELECTIVE SPINAL IMMOBILIZATION
Background: This parameter is intended to provide personnel with a guideline for the selective exclusion from spinal restriction on patients who have a low index of suspicion mechanism of injury for spinal injury combined with a thorough assessment that supports the exclusion.
Why not use C-collars for spinal trauma?
A performed analysis of physics, biomechanics and physiology involved in spinal trauma recommended not using hard backboards for transport, especially in the case of ambulatory, uncooperative or seizing patients, and not using C-collars except in specific injury types. 1. An added benefit of eliminating unnecessary use of spinal immobilization ...
Where is the CCR spinal algorithm used?
The Northern Territory and Queensland Ambulance Services in Australia are excellent examples of an EMS service outside the province of Canada using the CCR spinal algorithm with similar results.
How are SCIs measured?
SCIs are measured either by morbidity rates or by degree of resulting impairment: motor, sensory or autonomic. 2 Prehospital care by EMS personnel is part of the larger spectrum of care that SCI patients receive, but statistics suggest that up to 25% of SCIs may be worsened during extrication after a motor vehicle crash (MVC) when using the status quo for spinal immobilization. A study that used healthy volunteers and video motion-capture methods found the motion of cervical spine (C-spine) was greater when volunteers were extricated onto a spine board than when they were able to exit the vehicle on their own, wearing a cervical collar (C-collar) for stabilization. 3
What percentage of spinal cord injuries are EDs?
Approximately 2% of all injuries that present to EDs are spinal cord injuries (SCIs). 1 While overall incidence may seem low, traumatic SCIs are a serious matter. In fact, one reason for adhering to strict immobilization assessment and guidelines is the extreme cost of missing the diagnosis of a spinal injury. This may be why practices for immobilizing a patient’s spine prior to hospital transport have been largely unchallenged for the last 30 years.
What is the C collar used for?
Immobilization is defined in this study as use of a C-collar for neck immobilization along with lateral supports and straps and a spinal head immobilizer. The authors emphasize immobilization as an integral part of trauma patient care that also includes oxygen support, blood pressure stabilization and measured volume replacement.
What is the CCR in EMS?
Clinical decision-making tools, like the Canadian C-spine rule (CCR), may provide an alternative to traditional mechanism of injury protocols such as the Prehospital Trauma Life Support (PHTLS) protocol. A trial comparing adherence and effectiveness of three traditional EMS protocols, including the PHTLS protocol, suggests traditional protocol adherence leads to unnecessary stabilization while non-adherence leads to injuries being missed and thus creating a potential lose-lose combination. 11
Does spinal immobilization help with gunshot wounds?
Two articles identify a specific trauma population– gunshot wound victims–that doesn’t benefit from prehospital spinal immobilization. 8,9 The difference in risk of death, which may be almost double, is attributed to the extra time it takes to stabilize the patient’s spine with a C-collar and strapping to a long board. In gunshot wounds, case time is the most critical aspect of care. A retrospective analysis of penetrating trauma patients in the National Trauma Data Bank lends further weight to the argument. 10 Of the 45,284 patients studied, mortality rate was almost twice as high in the spine-immobilized patients, leading the authors to conclude that spinal immobilization may not be indicated for head, neck or torso injury in the absence of neurological deficit of complaint.
What is a long spine board?
The long spine board provides a safe method of movement. Aggressive training on how to move the patient to the stretcher sans long board will have to be developed. Further, instruction and emphasis on the scoop stretcher for this purpose is needed. Along with this, methods for limiting spinal movement once on the stretcher need to be made part of the National Standard Curriculum for EMS providers.
What is a C collar?
The C-collar i s very similar in design to the devices used to provide long and short-term immobilization for patients who have suffered significant injury to their neck. Therefore, despite there being no documented evidence to support their use in the emergency situation, their use after diagnosis supports their emergency use as a standard of care.
Does EMS have spinal immobilization?
Throughout the past several years, since the NEXUS and Canadian C-spine rules were published, EMS has slowly but steadily adopted selective spinal immobilization protocols. This alone has significantly reduced the number of patients needlessly strapped to backboards and placed in C-collars. But the question now before us is: Once it’s determined a patient may require spinal immobilization, what’s the most appropriate method?
Can a patient sit on a stretcher?
A standing patient can be coached to sit on the stretcher . A three-person assist to the supine position with head stabilization is then an easy maneuver, but removal of patients either from a vehicle or other situation may not be as easy. The long spine board provides a safe method of movement.
Can you use a backboard for spinal immobilization?
It doesn’t require the use of the traditional backboard but instead states that for patients suspected of a spinal injury, appropriate methods to reduce potentially harmful movement of the spine should be used. There’s growing literature to support the use of the scoop stretcher or vacuum mattresses for spinal immobilization. Patients placed on a backboard should be removed from it as soon as practical in the emergency department.
