Cervical Spine Immobilization

Aka: Cervical Spine Immobilization, Cervical Collar, C-Collar, Manual Inline Stabilization of Cervical Spine, Cervical Spine Protection, C-Spine Protection, C-Spine Immobilization

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II. Technique: Cervical Spine Immobilization

  1. Indications
    1. Loss of consciousness with Trauma
    2. Significant multi-system Trauma or high energy injury
    3. Severe head or facial Trauma
    4. Neurologic deficit
      1. Extremity Paresthesias or numbness
      2. Extremity weakness
    5. Neck Pain or Neck tenderness
    6. Multiple painful injuries (distracting injuries)
    7. Altered Level of Consciousness: Alcohol or drugs
    8. No history available
    9. Setting suggests Traumatic Injury
    10. References
      1. Stroh (2001) Ann Emerg Med 37:609-15 [PubMed]
  2. Technique
    1. Immobilize spine completely
      1. Apply Cervical Collar
      2. Backboard is for moving patient to a gurney and then to emergency department
        1. Once on a stable firm emergency department bed, remove Backboard as soon as possible
      3. Do not place on Spine Board until adequate support
        1. Proper log-roll requires 3-4 trained persons
        2. One person is assigned to stabilize the neck
    2. Do not move patient until complete immobilization
      1. Exception: Imminent environmental danger
    3. Special circumstances: Football injury
      1. Immobilize with helmet and pads in place
        1. Sideline removal excessively moves Cervical Spine
      2. Leave both helmet and Shoulder pads in place
        1. C-spine is malaligned if one of the 2 is removed
        2. Face Mask may be removed if face access is needed
      3. References
        1. Gastel (1998) Ann Emerg Med 32:411-7 [PubMed]
        2. Palumbo (1996) Am J Sports Med 24:446-53 [PubMed]

III. Precautions

  1. Cervical Collars are still considered standard of care in possible Cervical Spine Injury (until guidelines change)
    1. Use Cervical Collar when indicated, but be aware of the controversy regarding its utility
    2. However, Cervical Collars are without strong evidence of benefit and may lead to harm
  2. Cervical Collars are not supported by evidence that they restrict harmful movement in C-Spine Injury
  3. Cervical Collars are NOT Indicated in Penetrating Trauma
  4. Cervical Collars may have significant adverse effects
    1. Interferes with airway management
      1. Gaither (2014) J Emerg Med 47(3):294-300 +PMID:24906900 [PubMed]
    2. Paradoxically may result in wore outcomes in Spinal Injury
      1. Hauswald (1998) Acad Emerg Med 5(3): 214-9 +PMID:9523928 [PubMed]
    3. Increases neck stiffness and pain
    4. May reduce venous return and increase Intracranial Pressure
  5. References
    1. Orman and Colwell in Herbert (2016) EM:Rap 16(2): 17
    2. Sundstrom (2014) J Neurotrauma 15;31(6):531-40 +PMID:23962031 [PubMed]
  6. Resources
    1. Sancrit.com
      1. http://www.scancrit.com/2013/10/10/cervical-collar/
      2. http://www.scancrit.com/2014/04/02/cervical-collar-r-i-p/

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