Overview:

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Overview

• Miami J and Miami Jr.
• Four Keys to Success
• 1. Size it Up!
• 2. Scoop it Up!
• 3. Snug it Up!
• 4. Skin Care.

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Simple Sizing SIZE IT UP!

• Simple Sizing Questions
• Sizing Silhouettes
• Phenotype-driven algorithm
• Quickly determine size through process of
  elimination.

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Does your patient have a kyphotic (chin-on-chest)
neck?
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200S Super Short
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• Kyphotic.
• Chin-on-chest.
• Geriatric.
• Osteoporitic and / or ankylosing spondylitic.

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200S Super Short
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Does your patient have a very large neck
circumference?
2.
200L Stout
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• Very large neck circumference.
• Obese.
• "No-neck".
• Massive

shoulders.
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Does your patient have a very short thin neck?
3.
250 XS
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• Very short thin neck.
• Principally female.
• More prevalent in the Asian population.
• Rare.

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Does your patient have a long tall neck?
4.
500 Large
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• Long, tall neck.
• "Swan neck".
• Young women.
• Adolescents.

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Is your patient female?
5.
400 Medium
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• Female.
• Standard size for mature women.
• Thin, mature men.

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All other adults.
6.
300 Small
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• Standard size for mature men.
• Heavy or swollen women.

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Review
Phenotype-driven Algorithm.
300
400
500
250
200L
200S
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Is your patient a child (12 years or under)?
7.

• Patented "Airway Back" design.
• Flared occiput uniquely maintains airway and
  c-spine alignment.
• Addresses anatomical growth transition from birth
  to adolescence.

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Pediatric Sizes
0 6 mos
0 3 mos
6 mos 2 yrs
Simple Sizing based on Age. Broselow Luten
scale.
2 6 yrs
6 12 yrs
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Pediatric Sizes Papoose

• Infant Spinal Immobilizer
• Broselow Gray (0 - 3mos.)
• Maintains airway and spinal alignment.
• Occipital shape prevents positional
  plagiocephaly.
• Allows continued intimacy between child and
  caregiver.
• Permits convenient diaper changes.
• Provides temporary immobilization for IV
  placement.

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Importance of Alignment AirWay PAD

• Children 12 and under Always apply padding from
  border of scapulae to base of spine to offset
  occipital prominence

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• Open airway.

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• Maintain c-spine alignment.

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Importance of Alignment AirWay PAD
11 yr. old with AirWay PAD
11 yr. old No collar, No Pad
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AirWay PAD Pediatric Alignment Device

• Open PAD.
• Measure Child.

• Choose Color.
• Fold PAD.

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Application C-Spine Precautions
1 - Two persons needed for initial collar
placement 2 - Maintain head and neck in proper
alignment
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• remove pillows
• arms to the side
• shoulders down
• head aligned centrally.

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Application Scoop It Up!
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Sides oriented up toward the ears off trapezius.
Slide Back behind neck.

• Flare sides out
• Slide up chest wall
• Scoop it up under
• chin

Sorbatex padding should extend beyond edge of
plastic.
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Application Snug It Up!
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Snug it up!

• Curl ends so they touch the neck
• Fasten Velcro strap

• aligned symmetrically
• oriented "Blue-on-Blue" to Front Velcro.

• Tighten straps alternately
• Eliminate all gaps

If patient can slip his/her chin inside the
collar, IT IS NOT SNUG ENOUGH.
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Fine Tuning Fit Sternal Pad

• Disperses ambulatory pressure.
• May be removed
• if anatomy dictates
• for comfort during sleep
• during meals.

Keep sternal pad for long term / at-home use.
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Fine Tuning Fit Angulation Buttons
COLLAR OFF Position to contour patients
anatomy and evenly distribute contact pressure.
Always move buttons toward the pressure.
CHIN SUPPORT

• Slide button up to relieve chin tip pressure.

• Slide button down to relieve jaw / mandibular
  pressure.

OCCIPITAL SUPPORT

• Slide up to relieve occipital pressure and direct
  edge toward the bed and away from the head
• Slide down to enhance extension control

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Fine Tuning Fit Assist Strap
Keep Assist Strap for long-term or at home use.
To use
- Attach strap to rivet inside collar. - Strap
will assist patient with independent application
and/or free hands of person applying collar.
Upright Application
Bring strap around back of neck and attach
loosely to blue Velcro.
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FINAL CHECKLIST

• A properly applied
• Miami J
• Chin
• Blue-on-Blue
• Trapezius
• Sorbatex pads
• Tracheal Opening

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Skin Care C-Spine Precautions
Immobilization should not be compromised for
skin/wound care. Two persons are required.
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Supine Patient
Bed flat and remove pillows.
Children 12 Under
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• Position Patient
• arms to the side
• shoulders down
• head aligned centrally

Pad under thorax to offset occipital prominence.
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Skin Care
Necessary Equipment soap water, wash cloth
towel, small pillow, and replacement pads.
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• Open velcro closure on left side.
• Wash neck collar w/ mild facial soap water.
• Replace soiled pads.
• Dry completely.
• Observe for redness, irritation or debris.
• Refasten collar.

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• Roll patient onto side.
• Place towel / pillow under cheek.

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Skin Care
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• Open collar and wash posterior neck collar w/
  mild facial soap water.
• Replace soiled pads.
• Dry completely.
• Observe for redness, irritation or debris.

• Securely re-fasten the collar
• Scoop it up!
• Snug it up!
• Check Blue Sorbatex pads are not folded. Pads
  should extend past the white plastic edges

If patient slips inside collar - not snug enough.
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Cleaning Instructions
A

• Wash pads and wipe shell with mild facial soap
  water.
• Rinse pads.
• Wring out water and lay pads to dry.
• Attach replacement pads.

B
C
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Skin Assessment

• Skin assessed every shift and prn.
• Pads changed/cleaned once/day and prn.
• Pressure, moisture, heat, dirt lead to skin
  breakdown.
• Change initial collar to extended wear within 2
  hours of arrival.
• Keep skin clean dry.
• Keep pads clean, dry free of debris.

Chronic dampness or redness may indicate use of a
Occian Back.
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Occian Back Indications

• Patients gt65 years
• Respiratory, neurological or hemodynamic
  instability
• High volume fluid resuscitation
• Long term ventilator patients
• Poor skin assessment
• Diabetes, malnourished
• Edema and blistering

Simply substitute the Occian Back for the Miami
J collar back piece. Technically advanced
IntuiTech memory foam prevents occipital
breakdown.
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Document

• Skin care and pad replacement.
• Skin integrity under collar / Action taken.
• Size and fit of collar.
• Maintenance of stability and neck alignment.
• C-spine radiological and clinical clearance.

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JTO Thoracic Extension

• One size fits all adult collars and P3
• Slide Back behind patient.
• Remove anterior portion of collar and apply chin
  strut.

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JTO Thoracic Extension

• Apply anterior brace.
• Position chin strut feet as low as possible
• Position Lower Front as high as possible
• Tighten all straps securely.

Indicated for cervical junction injuries when
additional stability at the limits of the c-spine
is desired.
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Review

• Size it Up!
• Simple Sizing Questions Sizing Silhouettes.
• Phenotype Driven Algorithm.
• Process of Elimination.
• Snug it Up!
• Blue-on-Blue.
• No slack or gaps in straps.
• Patient cant drop chin into collar.

• Scoop it Up!
• Front of collar directed UP toward the ears.
• No plastic digging into shoulders.
• Curl edge around back of neck.
• Skin Care
• Keep the pads clean!
• Check for redness.
• Fine-tune fit as necessary.

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