Spinal Trial

Question 1

what does Nutbeam et all suggest about verbal instructions and cervical collars?

Answer 1

When a collar is applied and there is no verbal instruction there is the least amount of movement in the spine if a patient is self extracting from a car.

Question 2

Does a spinal board help to reduce lateral movment?

Answer 2

No this was found in the study Spinal immobilisation does not help to immobilise the cervical spine.

Question 3

What was found in the study “spinal immobilisation does not decrease the rates of spinal chord injury?

Answer 3

That acute spinal immobilisation may not benefit for the prevention of neurological damage from unstable spinal injury.

Question 4

If a patient has a blunt spinal injury how well does spinal immobilisation on a spinal board prevent neurological damage?

Answer 4

It has been found that immobilisation has little or no effect on neurological damage post blunt force injury to the spin.

Question 5

is it harder to mange airways when a rigid spinal collar is applied?

Answer 5

It is more difficult, takes more manoeuvres and take longer to intubate patens with collar but has equivalent success rate.

Question 6

Dose immobilisation cause any problems?

Answer 6

Immobilisation using a spinal board or collar causes pressure ulcers. Spinal boards should only be used for extraction. If there is a prolonged time for collars to be worn these should be swapped out from rigid to more comfortable soft ones.

Question 7

Does spinal immobilisation have an impact on the physical exam?

Answer 7

Immobilisation >30mins causes midline spinal tenderness which can indicate false-positives for spinal trauma/injury.

Question 8

Does spinal immobilisation cause a decrease in pulmonary function?

Answer 8

When fully immobilised there can be a 17% reduction in pulmonary function due to restrictive decreases.

Question 9

Dose the application of rigid collars increase intercranial pressure?

Answer 9

It has been found that inter cranial pressure does rise with the application of collars, this Varys between studies and individuals. Stiff collars should be removed as early as possible

Question 10

What is the bottom line of spinal immobilisation with long spinal boards say about the efficacy of this treatment option?

Answer 10

There is not much evidence that it is beneficial to spinally immobilise a patient that is awake, alert and without defects/complaints.

• Doesn’t decrease injury/neurological damage or movement of spin
• Does increase ICP, false positives on physical exam, decrease pulmonary function and make intubation more difficult.