Makindo Medical Notes

Related Subjects: |Spinal Cord Anatomy |Initial Trauma Assessment and Management |Cervical Spine Immobilization and Management |Anatomy of the Cervical Vertebrae C1 (Atlas) and C2 (Axis) |Trauma: Spinal Injury

Indications for Cervical Spine Immobilization and Management

Cervical spine immobilization is essential for trauma patients to prevent further spinal injuries. This is especially crucial in those presenting to the emergency department with altered levels of consciousness and a history or evidence of trauma that may cause spinal injury.

High-Risk Mechanisms of Injury

• Falls from a height greater than 3 meters.
• Axial load to the head (e.g., diving injuries).
• High-speed motor vehicle collisions (MVC).
• Motorized recreational vehicle accidents.
• MVC with vehicle rollover or ejection of the patient.
• Collision involving bicycles or being struck while on a bicycle.
• Age > 65 years with cervical spine pain following trauma.
• Presence of paresthesia in extremities following a traumatic incident.

Aims of Care: Prevent further spinal injury through prompt application of a cervical immobilization collar and adherence to spinal precautions and protocols.

Spinal Precautions Protocols

• Staff Education: Training and accreditation in spinal precautions and handling patients with potential spinal injuries.
• Preventing Complications of Immobilization:
  • Meticulous collar care and maintenance.
  • Frequent turning and attention to pressure areas.
  • Early upright positioning based on imaging results.
• Early Spinal Clearance:
  • Timely completion of necessary imaging (X-ray, CT, or MRI).
  • Clear communication between healthcare professionals and teams.
  • Proper and timely documentation of clinical findings and care provided.

Guidelines for Applying Semi-Rigid Cervical Collars

• A semi-rigid cervical collar should be applied to all patients with multi-trauma or head injuries until spinal injury is ruled out.
• Use the Canadian C-Spine rule to determine if a patient is at risk of spinal injury and requires a cervical collar.
• Patients assessed as low-risk or without evidence of spinal injury may have the cervical collar removed after a thorough clinical assessment.

Equipment & Materials Required

• Standard mattress (x-ray board optional).
• Cardiac-monitored bed within direct sight of staff.
• Immediate access to a call notification system and equipment for log rolling.
• Minimum of 3 accredited staff members for patient handling.
• Cervical spine immobilization device - Philadelphia collar.
• Personal protective equipment (PPE).
• Hand hygiene materials and access.
• Access to X-ray, CT scanner, and/or MRI.

Key Principles of Spinal Immobilization

• These guidelines assist in managing patients with suspected cervical spine injuries:
  • Stable patients with normal mental status can often have their cervical spine cleared without imaging using clinical assessment.
  • Patients who cannot be cleared clinically may require a combination of cervical spine imaging and clinical review.
  • Inline cervical spine immobilization must be maintained until clinical clearance is achieved.
  • Patients with altered mental status cannot have their cervical spine fully cleared until they are fully alert, regardless of initial clinical findings.
  • Senior clinicians should be involved when there is uncertainty in applying these guidelines.

Complications of Prolonged Spinal Immobilization

• Pressure ulcers, especially related to prolonged use of cervical collars.
• Increased intracranial pressure.
• Need for sedation and potential delays in weaning from mechanical ventilation.
• Intolerance to enteral feeding due to supine positioning.
• Risk of pulmonary aspiration due to positioning.
• Development of deep vein thrombosis (DVT).
• Increased respiratory complications and risk of infection.

References

• Cervical Spine Immobilization and Management – Adult and Paediatric