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Does a cervical collar immobilization device improve patient outcomes - Research Paper Example

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Does a cervical collar immobilization device improve patient outcomes? During any accident, in the prehospital stage, spinal immobilization is considered to be an effective strategy to prevent further injury to the spine and spinal cord when the patient is being shifted to the hospital for further management…
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Does a cervical collar immobilization device improve patient outcomes
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Download file to see previous pages One of the reasons for such uncertainty is the lack of effective measure to evaluate and ascertain the extent of injury to the patient in the prehospital stage in the emergency scenario. Another reason is the lack of proper definition for immobilization. While some experts recommend immobilization as a routine protocol in all resuscitation protocols, a few of them question the very application of cervical immobilization arguing that it has very little impact on the outcomes of the patient. In many hospital protocols, selective spinal immobilization has been employed and the emergency medical personnel decide whether cervical immobilization, cervical collar or long spine board is necessary for the patient. It is a well known fact that early management of an individual with suspected or potential cervical spine injury begins at the accident scene. This is because of the chief concern that impairment of the neurologic function can ensue due to pathologic motion of the vertebrae that are injured. It has been estimated that 3- 25 percent of spinal cord injuries occur after the traumatic insult during early treatment or transit. Mishandling of cervical spine results in poor outcomes. Thus, spinal immobilization has become an integral part of prehospital spinal care until injury to the spine is rules out. A cervical collar, also known as neck brace, is a medical equipment which is used to support the cervical spinal cord of the patient. The collar mainly stabilizes the cervical vertebrae C1-C7. The exact definition of cervical spinal immobilization is yet unclear. In a retrospective study by Jin et al (p.401), the researchers examined the sensitivity of a prehospital protocol in which there are 5 criteria for immobilization of spine and they are presence of any neurological deficit, decreased awareness in terms of time, person and place, presence of intoxication, pain on palpation of the spine and age of atleast 65 years. This study included 238 victims of trauma. Of these, atleast 236 individuals had atleast one of the five criteria and thus received immobilization. Of the 2 cases who has no positive findings and hence did not receive any immobilization, one had a small fissure in the arch of C2 and the other had fracture of the transverse process of L3. Both the patients were discharged within 24 hours. Thus, it can be said that hospital protocols for spinal immobilization can be sensitive upto 99.2 percent. The effectiveness and benefits of immobilization of the spine depends on the perfection in application of the immobilization technique. Generally, immobilization of spine consists of a cervical collar that supports either side of the head, and the long and short back boards which have straps attached to them to immobilize the rest of the body. Mozalewski (cited in AANS, p.6) opined that unless the motion of trunk also was minimized along with motion of head, spine immobilization was ineffective. The literature review by AANS (p.6) drew some implications about spine immobilization practices in an emergency setting. The review opines that studies pertaining to spinal immobilization are limited because none of the studies actually evaluate the full range of available devices. However, from whatever results are available, it appears that a combination of cervical collar immobilization with supportive straps on a rigid long spinal ...Download file to see next pagesRead More
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