Goals of this Cervical Spine Immobilization In-service

1. Goals of this Cervical Spine Immobilization In-service • Learn: • When to immobilize cervical spine • When not to immobilize the cervical spine • What are the potential complications of cervical spine immobilization.

2. When should you suspect a cervical spine injury? • You should suspect a cervical spine injury when the anatomy, mechanism or complaints suggest a cervical spine injury is possible.

3. Anatomy, Mechanism and Complaint Anatomy: If the visual picture of the scene suggests a cervical spine injury is possible. Mechanism: If the history suggests a cervical spine injury is possible, suspect a c-spine injury in any patient with trauma above the clavicles and in any patient found on the ground unconscious . Complaint: If the patient complains of neck pain and they have a history or mechanism of injury which could injure their neck. Additionally you should suspect cervical spine injury if mechanism exists in a patient who is under the influence of, i.e. using drugs or alcohol or who has a head injury or distracted by painful injury.

4. Anatomy- Visual Picture of the patient/scene: • Patient is unconscious and anatomy, i.e. placement of head/neck or body suggests injury to c-spine. • Example: Patient found crumpled at the bottom of the stairs, head under torso or head is lowest part of body prone on the stairs. • Example: Patient suffered blow to head or neck, any point above the clavicle can cause c-spine injury.

5. Anatomy-continued • Example: Patient is occupant of car which displays signs of rollover damage or significant intrusion into passenger compartment.

6. Mechanism Patient’s history is consistent with a c-spine injury. • Example: The patient reports diving into shallow water head first. • Example: Patient fainted and fell striking their head on a piece of furniture or the ground. • Example: Patient rolled their vehicle or patient ejected from vehicle.

7. Complaint: • Patient is complaining of neck pain, after a mechanism occurs which could injure his/her c-spine. • For example when patient complains of neck pain in the setting of motor vehicle accident • For example a patient with a traumatic head or facial injury complains of neck pain. • Remember Altered Patients or Patients with distracting painful injuries may not complain.

8. When is it safe or appropriate not to c-spine trauma patients?? • Patient who is awake, alert, unaltered by a head injury, alcohol, drugs, and has no distracting painful injury and doesn’t have neck pain.

9. Why not c-spine them all? • Patients in c-spine are supine and strapped down, so they can have trouble maintaining a patent airway. • Patients in c-spine precautions who vomit can aspirate, and potentially have a respiratory arrest. • Patients strapped to a backboard for long periods of time can develop pressure sores: their skin breaks down to open bleeding sore.

10. What if you are unsure? • If the patient has no anatomy, mechanism or complaint, then they probably do not need a cervical collar. • If the patient has one of the above and doesn’t meet the criterion of being awake, alert, and unaltered by a head injury, alcohol, drugs, and not having a painful distracting injury they probably should be c-spined.

11. What do we do when our c-spined patient vomits? Turn the patient on the board on their side with you supporting their head. Suction as needed. Then return to regular position.