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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
- See Also
- Four-Person Log Roll
- Spine Board
- Trauma Evaluation
- Cervical Spine Injury
- Thoracolumbar Injury
- Cervical Spine Imaging in Acute Traumatic Injury
- Technique: Cervical Spine Immobilization
- Indications
- Loss of consciousness with Trauma
- Significant multi-system Trauma or high energy injury
- Severe head or facial Trauma
- Neurologic deficit
- Extremity Paresthesias or numbness
- Extremity weakness
- Neck Pain or Neck tenderness
- Multiple painful injuries (distracting injuries)
- Altered Level of Consciousness: Alcohol or drugs
- No history available
- Setting suggests Traumatic Injury
- References
- Stroh (2001) Ann Emerg Med 37:609-15 [PubMed]
- Technique
- Immobilize spine completely
- Apply Cervical Collar
- Backboard is for moving patient to a gurney and then to emergency department
- Once on a stable firm emergency department bed, remove Backboard as soon as possible
- Do not place on Spine Board until adequate support
- Proper log-roll requires 3-4 trained persons
- One person is assigned to stabilize the neck
- Do not move patient until complete immobilization
- Exception: Imminent environmental danger
- Special circumstances: Football injury
- Immobilize with helmet and pads in place
- Sideline removal excessively moves Cervical Spine
- Leave both helmet and Shoulder pads in place
- C-spine is malaligned if one of the 2 is removed
- Face Mask may be removed if face access is needed
- References
- Gastel (1998) Ann Emerg Med 32:411-7 [PubMed]
- Palumbo (1996) Am J Sports Med 24:446-53 [PubMed]
- Precautions
- Cervical Collars are still considered standard of care in possible Cervical Spine Injury (until guidelines change)
- Use Cervical Collar when indicated, but be aware of the controversy regarding its utility
- However, Cervical Collars are without strong evidence of benefit and may lead to harm
- Cervical Collars are not supported by evidence that they restrict harmful movement in C-Spine Injury
- Cervical Collars may have significant adverse effects
- Interferes with airway management
- Gaither (2014) J Emerg Med 47(3):294-300 +PMID:24906900 [PubMed]
- Paradoxically may result in wore outcomes in Spinal Injury
- Hauswald (1998) Acad Emerg Med 5(3): 214-9 +PMID:9523928 [PubMed]
- Increases neck stiffness and pain
- May reduce venous return and increase Intracranial Pressure
- References
- Orman and Colwell in Herbert (2016) EM:Rap 16(2): 17
- Sundstrom (2014) J Neurotrauma 15;31(6):531-40 +PMID:23962031 [PubMed]
- Resources
- Sancrit.com
- http://www.scancrit.com/2013/10/10/cervical-collar/
- http://www.scancrit.com/2014/04/02/cervical-collar-r-i-p/