Spinal Immobilization in Trauma Patients – The Facts

  • There is no high-level evidence that prehospital spinal immobilization positively impacts patient-oriented outcomes
    • Spinal Immobilization Does NOT Help Immobilize the Cervical Spine
    • Spinal Immobilization Does NOT Decrease Rates of Spinal Cord Injury
    • Spinal Immobilization Increases the Difficulty of Airway Management
    • Spinal Immobilization Can Cause Pressure Ulcers
    • Spinal Immobilization Changes the Physical Exam
    • Spinal Immobilization Worsens Pulmonary Function
    • Spinal Immobilization Increases Intracranial Pressure
  • There is no evidence that immobilizing awake, alert patients without deficits/complaints provides benefit
  • Selective spinal immobilization protocols can help identify patients at low risk for injury and avoid immobilization

 

Pre-hospital Management of Spinal Injuries: Backboard Myths

Spine Board Myths

  1. The Backboard should not be used as a therapeutic intervention. Achieving full spinal immobilization is not possible and its use has been shown to cause patient harm and no benefit. Instead, spinal motion restriction should be practiced.
  2. Backboard use has been shown to cause increased pressure ulcers, decreased respiratory function, increased back pain, and result in a false-positive midline vertebral tenderness. This can result in unnecessary testing, radiation exposure and medical costs.
  3. Penetrating trauma alone does not increase the risk of cervical spine injury and these patients should never be immobilized.
  4. Attempting spinal motion restriction should not delay life-saving interventions or delay transport to definitive care.
  5. Remove backboards in the emergency department to avoid complications of prolonged, unnecessary immobilization.

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Goodbye C-Collar

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Published reports of early secondary neurologic deterioration after blunt spinal trauma are exceptionally rare and generally poorly documented. High-risk features may include altered mental status and ankylosing spondylitis. It is unclear how often events are linked with spontaneous patient movement and whether such events are preventable.

EMS: C-Collars…time to dump them!

dustbin

Conclusions These data support the findings of the proof of concept study, for haemodynamically stable patients controlled self-extrication causes less movement of the cervical spine than extrications performed using traditional prehospital rescue equipment.

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Choosing wisely: Unnecessary tests and treatments cost money and harm your patient financially (DO NO HARM)!

  1. Don’t order CT head scans in adults and children who have suffered minor head injuries (unless positive for a head injury clinical decision rule).
  2. Don’t prescribe antibiotics in adults with bronchitis/asthma and children with bronchiolitis.
  3. Don’t order lumbosacral (low back) spinal imaging in patients with non-traumatic low back pain who have no red flags/pathologic indicators
  4. Don’t order neck radiographs in patients who have a negative examination using the Canadian C-spine rules.
  5. Don’t prescribe antibiotics after incision and drainage of uncomplicated skin abscesses unless extensive cellulitis exists.

APLS like everyone else has finally gotten rid of the cervical collar…have you?

MILS

“Consider protecting the cervical spine if the mechanism of injury suggests the possibility of a cervical spine injury. If protection is considered necessary, start with manual in-line stabilisation (MILS) by a competent assistant or if this is not possible, consider using head block and appropriate strapping”