Trauma Resuscitation — Cervical Spine (C-Spine) Immobilization — Clinical Pathway: Emergency

Trauma Resuscitation Clinical Pathway — Emergency Department

Cervical Spine (C-Spine) Immobilization

Goal

Identify and immobilize patients at risk for C-spine injury

Cervical immobilization indications after BLUNT trauma
Imaging Considerations
  • Abnormal level of alertness
  • Intoxicated
  • Focal neurological deficits
  • Distracting injury
    • Some examples include:
      • Severe abdominal, chest trauma
      • Significant long bone fracture
      • Degloving injuries
  • Posterior midline tenderness
  • High-energy mechanism of injury
    • Falls > 10 feet
    • Motor-vehicle collision > 35 mph
    • Unrestrained, improperly restrained passenger
    • Pedestrians, cyclists struck by vehicle with injury proximal to knee, elbow
    • Axial load injury
  • Suspected Abusive Head Trauma
  • Loading mechanism
  • Predisposing condition (such as Trisomy 21)
  • Significant torso injury
  • Fracture of spine at any level
  • Torticollis
Patient arrives in cervical collar (C-Collar) after BLUNT trauma
  • If patient has normal range of motion and no midline/bony pain AND
  • none of above indications are present,
  • cervical spine is cleared without imaging
Cervical immobilization indications after PENETRATING trauma
  • Cervical immobilization is NOT routinely indicated after penetrating trauma.
  • Maintain or place in appropriately fitting C-Collar if:
    • Evidence or concern for penetrating injury to cervical spine
    • Unclear mechanism or suspicion that patient had secondary blunt mechanism of injury

Evaluation and Clearance of Cervical Spine Immobilization Job Aid

Manual Cervical Immobilization

  • C-collars remind the patient and staff that the neck should remain immobile until evaluation is completed by the team.
  • Collars allow a significant amount of movement of the c-spine.
  • Movement of the patient during procedures with high risk of c-spine distraction should be done with manual C-spine immobilization.
  • Log-roll and patient movement:
    • Clinician holds c-spine immobilization from behind the patient’s head.
    • All movement is coordinated by the clinician holding c-spine immobilization.
  • Intubation:
    • Intubation is done with the front of the c-collar open/off and manual c-spine immobilization either from behind the patient’s head or from patient’s chest.

c-collar on patient

 

References