Spinal precautions explained

Spinal precautions

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. 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. 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. 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.[4] [5] [6] 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. In those with penetrating neck or head trauma spinal immobilization may increase the risk of death.[4] 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.[7]

Cervical spine clearance

See main article: Clearing the cervical spine. 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.[8] However, following either rule is reasonable.[9]

Side effects

Concern with use include: pain, agitation, and pressure ulcers.[10] 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]

Notes and References

  1. Book: Pollak, Andrew. Refresher: Emergency Care and Transportation of the Sick and Injured. 1999. 9780763709129. 302.
  2. Ahn. H. Singh. J. Nathens. A. MacDonald. RD. Travers. A. Tallon. J. Fehlings. MG. Yee. A. Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines.. Journal of Neurotrauma. August 2011. 28. 8. 1341–61. 20175667. 10.1089/neu.2009.1168. 3143405.
  3. Oteir. AO. Smith. K. Jennings. PA. Stoelwinder. JU. The prehospital management of suspected spinal cord injury: an update.. Prehospital and Disaster Medicine. August 2014. 29. 4. 399–402. 25046238. 10.1017/s1049023x14000752. 19574297.
  4. Oteir. AO. Smith. K. Stoelwinder. JU. Middleton. J. Jennings. PA. Should suspected cervical spinal cord injury be immobilised?: A systematic review.. Injury. 12 January 2015. 25624270. 10.1016/j.injury.2014.12.032. 46. 4. 528–35.
  5. Sundstrøm. T. Asbjørnsen. H. Habiba. S. Sunde. GA. Wester. K. Prehospital use of cervical collars in trauma patients: a critical review.. Journal of Neurotrauma. 15 March 2014. 31. 6. 531–40. 23962031. 10.1089/neu.2013.3094. 3949434.
  6. Web site: THE USE OF CERVICAL COLLARS IN SPINAL MOTION RESTRICTION . internationaltraumalifesupport.remote-learner.net . ITLS . 10 September 2020.
  7. Stuke. LE. Pons. PT. Guy. JS. Chapleau. WP. Butler. FK. McSwain. NE. Prehospital spine immobilization for penetrating trauma--review and recommendations from the Prehospital Trauma Life Support Executive Committee.. The Journal of Trauma. September 2011. 71. 3. 763-9; discussion 769-70. 21909006. 10.1097/ta.0b013e3182255cb9.
  8. Michaleff. ZA. Maher. CG. Verhagen. AP. Rebbeck. T. Lin. CW. 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 . 6 November 2012. 184. 16. E867-76. 23048086. 10.1503/cmaj.120675. 3494329.
  9. Ackland. H. Cameron. P. Cervical spine - assessment following trauma.. Australian Family Physician. April 2012. 41. 4. 196–201. 22472679.
  10. White CC. 4th. Domeier, RM . Millin, MG . Standards and Clinical Practice Committee, National Association of EMS, Physicians . 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. Apr–Jun 2014. 18. 2. 306–14. 24559236 . 10.3109/10903127.2014.884197. 207521864.
  11. Ham. W. Schoonhoven. L. Schuurmans. MJ. Leenen. LP. Pressure ulcers from spinal immobilization in trauma patients: a systematic review.. The Journal of Trauma and Acute Care Surgery. April 2014. 76. 4. 1131–41. 24662882. 10.1097/ta.0000000000000153. 23746350.

This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Spinal precautions".

Except where otherwise indicated, Everything.Explained.Today is © Copyright 2009-2024, A B Cryer, All Rights Reserved. Cookie policy.