All tied up

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All tied up no place to go
Abdul Aziz Parker
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Why we do what we do

• Estimated that 3 to 25 of spinal cord injuries
  occur after initial traumatic insult
• During 1970s 55 of patients had complete
  neurologic lesions
• During 1980s 61 of patients had incomplete
  neurologic injuries

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Who needs spine board

• All patients with potential spinal injury after
  trauma
• 1989 Garfin stated no patient should be
  extricated from a crashed vehicle or
• transported from an accident scene without
  spinal immobilization

• Decline in percentage of complete SCI from 1970s
  to 39 in 1980s

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How we do it

• A hard backboard
• Rigid cervical collar
• Lateral support devices
• Tape or straps to secure everything in place

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Methods to the madness

• Comparative studies with various devices done on
  healthy volunteers
• Methods used to assess spine motion include
  X-Ray, CT, MRI, plumb lines, cinematog

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How and where does the c-spine go

• All patients should have their c-spine placed in
  neutral position
• Except
• if pt is conscious and there is pain upon
  starting movement
• pt holds head in angulated position and
  states they are
• unable to move it
• if pt unconscious severe muscle spasm upon
  attempting maneuver
• space limitations

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What is the neutral position

• Schreiger the normal anatomic position of the
  head and torso one assumes
• when standing and looking ahead
• 12 degrees of cervical spine extension on lateral
  X-Ray
• De Lorenzo MRI showed flexion equivalent to
  2cm occipital elevation
• produces favorable increase in spinal canal /
  spinal cord ratio C5/C6

• McSwain Arnold Schwarzenegger vs. Laverne

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What do we use

• Backboard
• Cervical collar soft collar to keep necks warm
• rigid collar affords no protection on its own
• Sandbags in combination with cervical collar
  offers superior c-spine protection
• reduces neck extension from 15 to 7,4 degrees
  (Podolsky et al)
• tad heavy and if falls on tilting can pull
  pts head with it
• Spider harness Perry et al observed that
  efficacy of c-spine immobilization limited
• unless torso strapped (studies by Mazolewski
  affirming statement)

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How to get patients on board

• Logroll still have movement at lumbar spine
• Haines maneuver
• Firemans lift

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What are we really doing?

• Weve got no evidence that c-spine immobilization
  is necessary in all patients
• Who do we apply it to and what guidelines are
  there
• What are the dangers of spinal immobilization

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What are we really doing?

• Weve got no evidence that c-spine immobilization
  is necessary in all patients
• Who do we apply it to and what guidelines are
  there
• What are the dangers of spinal immobilization

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Dangers

• Pain common among all patients restrained
• can be improved with use of vacuum splint
  mattress

An Neann Vacmat Vacuum Mattress for the
transportation of trauma patients over long
distances.  The splint is made up of a tuff tarp
type outer skin filled with tiny balls about 1 mm
in diameter. The mattress is placed under the
patient and then air is sucked out of the splint
to form a rock hard device preventing body
movement. The mattress is used for patients being
transferred with spine, pelvic and leg injuries.
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Dangers

• Raised ICP Davies (Injury 1996) demonstrated
  4mmHg rise in ICP
• Hunt (Anaesthesia 2001) greater rise in pt
  with ICP gt 15mmHg
• due to decreased venous return

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Dangers

• Pressure sores pts not turned in first two
  hours (Linares)
• duration on spine board significantly
  associated with decube ulcer
• Marginal mandibular nerve palsy

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Dangers

• Aspiration
• Decreased respiratory function
• Bauer et al and Totten et al demonstrated a
  15 decrease in
• overall pulmonary function (FEV1, FVC,
  FEV1FVC, PEF)

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Thanx and let's play