Makindo Medical Notes.com

Indication criteria

• Patients presenting to the emergency department with altered level of consciousness and history or evidence of traumatic injury/fall that has the potential to cause spinal injuries.

High risk mechanism of injury is:

• Fall from elevation >3m
• Axial load to head
• Motor vehicle collision (MVC) at highspeed
• Motorised recreational vehicles
• MVC with rollover or patient ejection
• Bicycle struck or collision
• > 65 years of age and cervical spinepain post traumatic injury
• Patients presenting withparaesthesia’s in extremities posttraumatic incident

Aims of care for trauma patients with potential spinal injuries are Prevention of possible further spinal injury by Application of cervical immobilisation collar

Instigation of protocols in regards to spinal precautions and restrictions

• Education and accreditation of staff members in spinal precautions andrestrictions
• Prevention of complications of immobilisation by
  • Strict collar care
  • Frequent turning and pressure area care
  • Upright positioning as soon as possible (ie. based on imaging)
  • Early spinal clearance by
    • Timely completion of imaging
    • Adequate and timely communication between health professionals/treatingteams
    • Appropriate and timely documentation

Guidelines for when to apply Semi-Rigid Cervical Collar

• All multi-trauma patients or patients with a head injury will have a semi-rigid cervicalcollar applied
• Patients at risk for spinal injury will have a semi-rigid collar applied as per theCanadian C-Spine rule
• Patients assessed not to be at risk for spinal injury; will have a cervical collar removed.

Equipment & Materials

• Standard mattress ( x-ray board optional )
• Cardiac Monitored bed within direct sight of staff
• Immediate access for log roll with call notification system in reach
• Minimum of 3 accredited staff members
• Cervical Spine immobilisation device - Philadelphia collar
• Personal protection equipment
• Hand hygiene material and access
• Access to X-ray and/ or CT Scanner and/ or MRI

Key Principles

• These guidelines were developed to assist the management of suspected cervical spineinjuries:
• Stable patients with normal mental status may have their cervical spines cleared using these clinical assessment guidelines without requiring cervical spine imaging.
• Many patients with normal mental status who cannot be initially cleared using clinicalassessment guidelines will require a combination of normal adequate cervical spineimaging and senor clinical review before being able to have their cervical spinecleared.
• Inline cervical spine immobilisation must be maintained until clinically able to clear thecervical spine.
• Patients with altered mental status cannot have their cervical spine completely cleareduntil fully alert regardless of clinical findings
• Clinical judgement is required in applying any guidelines, senior clinicians should beinvolved if doubt exist

Prolonged spinal immobilisation may cause significant complications if not managedappropriately including

• Decubitus ulceration, especially related to cervical collars
• Increased intracranial pressure
• Increased need for sedation and potential mechanical ventilation weaning delay
• Enteral feeding intolerance relating to supine positioning
• Pulmonary aspiration due to supine positioning
• Deep venous thrombosis
• Increased respiratory compromise and infection

References

• Cervical Spine Immobilisation and Management – Adult and Paediatric