Medicine:Spinal precautions
| Spinal precautions | |
|---|---|
 A person with a hard cervical collar on a long board |
Spinal precautions, also known as spinal immobilization and spinal motion restriction, are efforts to prevent movement of the spine in those with a risk of a spine injury.[1] This is done as an effort to prevent injury to the spinal cord.[1] It is estimated that 2% of people with blunt trauma will have a spine injury.[2]
Uses
Spinal immobilization was historically used routinely for people who had experienced physical trauma.[3] There is; however, little evidence for its routine use.[3] Long spine boards are often used in the prehospital environment as part of spinal immobilization.[4] Due to concerns of side effects the National Association of EMS Physicians and the American College of Surgeons recommend its use only in those at high risk.[4] This includes: those with blunt trauma who have a decreased level of consciousness, pain or tenderness in the spine, those with numbness or weakness believed to be due to a spinal injury, and those with a significant trauma mechanism that are intoxicated or have other major injuries.[4] In those with a definite spinal cord injury immobilization is also recommended.[2]
Neck
There is little high quality evidence for spinal motion stabilization of the neck before arrival at a hospital.[5][6][7] Using a hard cervical collar and attaching a person to an EMS stretcher may be sufficient in those who were walking after the accident or during long transports.[4] In those with penetrating neck or head trauma spinal immobilization may increase the risk of death.[5][8] If intubation is required the cervical collar should be removed and inline stabilization provided.[2]
Mid and low back
Spinal motion stabilization is not supported for penetrating trauma to back including that caused by gun shot wounds.[8]
Cervical spine clearance
Paramedics are able to accurately determine who needs or does not need neck immobilization based on an algorithm.[2] There are two main algorithms, the Canadian C-spine rule and NEXUS. The Canadian C-spine rule appears to be better.[9] However, following either rule is reasonable.[10]
Side effects
Concern with use include: pain, agitation, and pressure ulcers.[4] A systematic review found cervical collar related skin ulcers from the devices in 7 to 38%.[11]
If a longboard is used, cushioning it is useful to decrease discomfort due to pressure.[2] A vacuum mattress and scoop board typically results in lower pressures.[2]
Mechanism of action
Studies with volunteers have found that using a hard collar, head stabilization with rolled up towels, and a long board decrease movement of the board.[2] What impact this has is unclear.[2]
References
- ↑ 1.0 1.1 Pollak, Andrew (1999). Refresher: Emergency Care and Transportation of the Sick and Injured. p. 302. ISBN 9780763709129. https://books.google.com/books?id=xuCTtGx_ukkC&pg=PA302.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Ahn, H; Singh, J; Nathens, A; MacDonald, RD; Travers, A; Tallon, J; Fehlings, MG; Yee, A (August 2011). "Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines.". Journal of Neurotrauma 28 (8): 1341–61. doi:10.1089/neu.2009.1168. PMID 20175667.
- ↑ 3.0 3.1 Oteir, AO; Smith, K; Jennings, PA; Stoelwinder, JU (August 2014). "The prehospital management of suspected spinal cord injury: an update.". Prehospital and Disaster Medicine 29 (4): 399–402. doi:10.1017/s1049023x14000752. PMID 25046238.
- ↑ 4.0 4.1 4.2 4.3 4.4 White CC, 4th; Domeier, RM; Millin, MG; Standards and Clinical Practice Committee, National Association of EMS, Physicians (Apr–Jun 2014). "EMS spinal precautions and the use of the long backboard - resource document to the position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma.". Prehospital Emergency Care 18 (2): 306–14. doi:10.3109/10903127.2014.884197. PMID 24559236.
- ↑ 5.0 5.1 Oteir, AO; Smith, K; Stoelwinder, JU; Middleton, J; Jennings, PA (12 January 2015). "Should suspected cervical spinal cord injury be immobilised?: A systematic review.". Injury 46 (4): 528–35. doi:10.1016/j.injury.2014.12.032. PMID 25624270.
- ↑ Sundstrøm, T; Asbjørnsen, H; Habiba, S; Sunde, GA; Wester, K (15 March 2014). "Prehospital use of cervical collars in trauma patients: a critical review.". Journal of Neurotrauma 31 (6): 531–40. doi:10.1089/neu.2013.3094. PMID 23962031.
- ↑ "THE USE OF CERVICAL COLLARS IN SPINAL MOTION RESTRICTION". ITLS. https://internationaltraumalifesupport.remote-learner.net/pluginfile.php/8290/mod_resource/content/1/Position%20Paper%20-%20Cervical%20Collar%20Use%20-%202019.pdf. Retrieved 10 September 2020.
- ↑ 8.0 8.1 Stuke, LE; Pons, PT; Guy, JS; Chapleau, WP; Butler, FK; McSwain, NE (September 2011). "Prehospital spine immobilization for penetrating trauma--review and recommendations from the Prehospital Trauma Life Support Executive Committee.". The Journal of Trauma 71 (3): 763-9; discussion 769-70. doi:10.1097/ta.0b013e3182255cb9. PMID 21909006.
- ↑ Michaleff, ZA; Maher, CG; Verhagen, AP; Rebbeck, T; Lin, CW (6 November 2012). "Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review.". Canadian Medical Association Journal 184 (16): E867-76. doi:10.1503/cmaj.120675. PMID 23048086.
- ↑ Ackland, H; Cameron, P (April 2012). "Cervical spine - assessment following trauma.". Australian Family Physician 41 (4): 196–201. PMID 22472679.
- ↑ Ham, W; Schoonhoven, L; Schuurmans, MJ; Leenen, LP (April 2014). "Pressure ulcers from spinal immobilization in trauma patients: a systematic review.". The Journal of Trauma and Acute Care Surgery 76 (4): 1131–41. doi:10.1097/ta.0000000000000153. PMID 24662882.
 |  |
