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 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
  4. 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]
  5. 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/

Images: Related links to external sites (from Bing)

Related Studies

Ontology: Cervical collar (device) (C0175751)

Concepts Medical Device (T074)
SnomedCT 63562005, 407741000
English Neck Collar, Cervical collar, device, Cervical collar (device), cervical collar (treatment), cervical collar, neck collar, cervical collars, Collars, Cervical, Cervical collar, Collar, Cervical collar, device (physical object), Cervical collar (physical object), Cervical Collar
Spanish collarín cervical (objeto físico), collarín cervical, cuello cervical, collar cervical (objeto físico), collar cervical

Ontology: Cervical spine immobilization (C1301792)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 398041008
Spanish inmovilización de la columna vertebral cervical, inmovilización de la columna vertebral cervical (procedimiento), inmovilización vertebral cervical
English immobilization of cervical spine (treatment), immobilization of cervical spine, Cervical spine immobilisation, Cervical spine immobilization (procedure), Cervical spine immobilization

Ontology: Manual inline stabilization of cervical spine (C3165197)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 449199004
English Manual inline stabilization of cervical spine (procedure), Manual inline stabilisation of cervical spine, Manual inline stabilization of cervical spine
Spanish estabilización manual en línea de columna vertebral cervical, estabilización manual en línea de columna vertebral cervical (procedimiento)