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Geldenhuys MJ, Downing C. Evidence-Based Nursing Care for Spinal Nursing Immobilization: A Systematic Review. J Emerg Nurs 2021; 46:318-337. [PMID: 32389205 DOI: 10.1016/j.jen.2020.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/08/2020] [Accepted: 02/11/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION A high degree of suspicion for spinal injury after trauma is commonplace in an emergency department, and spinal immobilization is considered an accepted intervention to prevent the progression of a potential injury. This systematic review was conducted to gain insight into the best research evidence related to nursing interventions for patients with trauma presenting with a suspected spinal injury. METHODS A systematic search of online databases was conducted in April 2019 for relevant research using specific search terms. The studies were selected on the basis of pre-established eligibility criteria, and the quality was appraised using the Critical Appraisal Skills Programme tool. RESULTS Nineteen included articles were synthesized thematically on the basis of the outcomes from interventions directed at a suspected spinal injury. The main findings were that spinal immobilization may compromise pulmonary function and airway management, cause pain and pressure ulcers, and be inappropriate with penetrating trauma. Furthermore, there was insufficient evidence to support the safety and efficacy of the hard neck collar and long backboard. DISCUSSION Patients would benefit from a more selective and cautious approach to spinal immobilization. Emergency nurses should use the evidence to facilitate informed decision-making in balancing the benefits of spinal immobilization against harm when considering the needs and values of the patient.
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Zileli M, Osorio-Fonseca E, Konovalov N, Cardenas-Jalabe C, Kaprovoy S, Mlyavykh S, Pogosyan A. Early Management of Cervical Spine Trauma: WFNS Spine Committee Recommendations. Neurospine 2021; 17:710-722. [PMID: 33401852 PMCID: PMC7788428 DOI: 10.14245/ns.2040282.141] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/06/2020] [Indexed: 12/12/2022] Open
Abstract
Epidemiology, prevention, early management of cervical spine trauma and it's reduction are the objectives of this review paper. A PubMed and MEDLINE search between 2009 and 2019 were conducted using keywords. Case reports, experimental studies, papers other than English language and and unrelated studies were excluded. Up-to-date information on epidemiology of spine trauma, prevention, early emergency management, transportation, and closed reduction were reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of World Federation of Neurosurgical Societies (WFNS) Spine Committee. The statements were voted and reached a positive or negative consensus using Delphi method. Global incidence of traumatic spinal injury is higher in low- and middle-income countries. The most frequent reasons are road traffic accidents and falls. The incidence from low falls in the elderly are increasing in high-income countries due to ageing populations. Prevention needs legislative, engineering, educational, and social efforts that need common efforts of all society. Emergency care of the trauma patient, transportation, and in-hospital acute management should be planned by implementing detailed protocols to prevent further damage to the spinal cord. This review summarizes the WFNS Spine Committee recommendations on epidemiology, prevention, and early management of cervical spine injuries.
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Affiliation(s)
- Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
| | | | - Nikolay Konovalov
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | | | - Stanislav Kaprovoy
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Sergey Mlyavykh
- Trauma and Orthopedics Institute, Privolzhsky Research Medical University, Nizhniy Novgorod, Russian Federation
| | - Artur Pogosyan
- N.N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
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Yoneoka Y, Akiyama K, Seki Y. Glass Fragment Injury to the Craniocervical Junction with Interatlantooccipital Penetration to the Subarachnoid Space: Not-To-Be-Missed Important Aspects of Craniocervical Trauma Even in the Middle of the COVID-19 Pandemic: Case Report and Review of Literature. World Neurosurg 2020; 141:402-405. [PMID: 32561491 PMCID: PMC7297170 DOI: 10.1016/j.wneu.2020.06.065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/07/2020] [Accepted: 06/07/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Nonmissile penetrating injuries to the craniocervical junction caused by a glass fragment are rare, and a standard management strategy has not been established. CASE DESCRIPTION A 75-year-old Japanese man was brought into our emergency department after receiving a left retroauricular stab wound by broken glass fragments. After spinal immobilization, a computed tomography (CT) scan revealed glass fragments penetrating at the right craniocervical junction to the interatlantooccipital subarachnoid space. CT angiography showed that both vertebral arteries were not injured. Magnetic resonance imaging demonstrated that the glass fragments did not penetrate the cervical cord or medulla oblongata. These glass fragments were removed via a midline incision from the external occipital protuberance to the C7 and with laminectomy without suboccipital craniectomy. Five of the glass fragments were found and removed in total. The dural defect was patched with a free fascia autograft. His postoperative course was uneventful. Postoperative CT angiography showed that both vertebral arteries were intact and the glass fragments had been removed completely. CONCLUSIONS CT graphical diagnosis is useful for the management of penetrating craniocervical junction trauma, and it should be considered in the evaluation of patients who have suffered craniocervical penetrating injury even in the absence of major wounds or bleeding. Spinal immobilization of patients with craniocervical penetrating injuries is crucial to avoid not only secondary neurologic damage but also secondary critical vascular damage. Incomplete or inadequate assessment of craniocervical stab wounds results in unexpected hazards that are preventable.
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Affiliation(s)
- Yuichiro Yoneoka
- Department of Neurosurgery, Uonuma Kikan Hospital, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Katsuhiko Akiyama
- Department of Neurosurgery, Uonuma Kikan Hospital, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yasuhiro Seki
- Department of Neurosurgery, Uonuma Kikan Hospital, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
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Dağar S, Çorbacıoğlu ŞK, Emektar E, Uzunosmanoğlu H, Çevik Y. Effects of spinal immobilization at 20° on end-tidal carbon dioxide. Am J Emerg Med 2020; 38:1180-1184. [PMID: 32122717 DOI: 10.1016/j.ajem.2020.02.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE The aim was to determine the effect on end-tidal carbon dioxide (ETCO2) of spinal immobilization (SI) at a conventional 0° angle and to investigate the usefulness of immobilization at a 20° angle for preventing possible hypoventilation. METHODS The study included 80 healthy volunteers, randomly divided into two groups. Spinal backboards and cervical collars were applied in Group 1 using a 0° angle and in Group 2 using a 20° angle, with the head up. SI was continued for 1 h, and ETCO2 values were measured at the 0th, 30th and 60th minute. RESULTS There were no significant differences between the groups in 0th and 30th minute ETCO2. However, after 60th minute, results showed a statistically significant increase in ETCO2 in Group 1 (35.5 mmHg [IQR 25-75:35-38]) compared to Group 2 (34 mmHg [IQR 25-75:33-36]) (p < 0.001). During SI, there was a statistically significant increase in ETCO2 in Group 1 (35 mmHg [IQR 25-75:34-36], 35.5 mmHg [IQR 25-75:34-37] and 36 mmHg [IQR 25-75:35-38] respectively at the 0th, 30th and 60th minute after SI) (p < 0.001) and no change in Group 2. Also, we found statistically significant differences between ΔETCO2 levels in Groups 1 and 2 at all 3 time intervals. CONCLUSION Conventional SI with an angle of 0° led to an increase in ETCO2 while subjects immobilization at a 20° angle maintained their initial ETCO2 values. Immobilization at 20° may prevent decompensation in patients who have thoracic trauma or lung diseases or those who are elderly, pregnant, or obese.
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Affiliation(s)
- Seda Dağar
- Kecioren Training and Research Hospital, Department of Emergency Medicine, Ankara, Turkey.
| | | | - Emine Emektar
- Kecioren Training and Research Hospital, Department of Emergency Medicine, Ankara, Turkey
| | - Hüseyin Uzunosmanoğlu
- Kecioren Training and Research Hospital, Department of Emergency Medicine, Ankara, Turkey
| | - Yunsur Çevik
- Kecioren Training and Research Hospital, Department of Emergency Medicine, Ankara, Turkey
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Abstract
Neck injuries are relatively uncommon but have the potential to cause serious and permanent disability. In athletes, injuries are most common in contact sports, and occur with direct axial loading with a forward-flexed neck. Soft tissue and peripheral nerve injuries are typically minor and self-limiting, with excellent recovery potential and return to activities based on symptoms. Concern for devastating spinal cord injuries has led to routine immobilization using spine boards and hard cervical collars. This approach may provide more harm than benefit when applied universally, and a more commonsense protocol can be used to better address potential neck injuries.
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Affiliation(s)
- Benjamin Oshlag
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Hospital, First Ave at 16th St, New York, NY 10003, USA.
| | - Tracy Ray
- Duke Sports Medicine, Duke University, 3475 Erwin Rd, Durham, NC 27705, USA
| | - Benjamin Boswell
- Dvision of Sports Medicine, Primary Care Sports Medicine, Department of Orthopedic Surgery, Department of Emergency Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Thorvaldsen NØ, Flingtorp LD, Wisborg T, Jeppesen E. Implementation of new guidelines in the prehospital services: a nationwide survey of Norway. Scand J Trauma Resusc Emerg Med 2019; 27:83. [PMID: 31464620 PMCID: PMC6716817 DOI: 10.1186/s13049-019-0660-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 08/20/2019] [Indexed: 12/01/2022] Open
Abstract
Background A debate regarding the potential harmful effects of rigid neck collar and backboard usage among prehospital and hospital care providers in Norway provoked the development of an evidence-based guideline. “The Norwegian guideline for the prehospital management of adult trauma patients with potential spinal injury” was developed with rigorous scientific methods and published in 2016. An e-learning course was developed in parallel. The aim of this study is to explore whether emergency medical services personnel in Norway have implemented the guideline, and to what extent the e-learning course was applied during the implementation process. Method An electronic survey was distributed individually to registered prehospital personnel in Norway 18 months after publication of the guideline. Results In all, 938 of 5500 (17%) EMS personnel responded to the survey. More than one-half confirmed knowledge of the guideline; among these, 56% claimed that the guideline was implemented in the service they work. Not having responded to trauma cases in real life was the main reason for not having executed the guideline. The e-learning course had been completed by 18% of respondents. Conclusion Although the guideline has not been authorized or made compulsory by national authorities, one-half of respondents with knowledge of the guideline reported it as implemented. E-learning did not seem to have affected the implementation. The guideline was developed based on perceived needs among care providers, and this probably facilitated implementation of the guideline. Electronic supplementary material The online version of this article (10.1186/s13049-019-0660-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nina Øye Thorvaldsen
- Emergency Medical Services, Division of Prehospital Services, Oslo University Hospital, Oslo, Norway. .,Faculty of Health Science, University of Stavanger, Stavanger, Norway.
| | - Lars Didrik Flingtorp
- Norwegian National Advisory Unit on Prehospital Emergency Medicine (NAKOS), Oslo, Norway
| | - Torben Wisborg
- Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.,Anesthesia and Critical Care Research Group, Faculty of Health Sciences, University of Tromsø - the Arctic University of Norway, Tromsø, Norway
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Özdoğan S, Gökçek Ö, Katırcı Y, Çorbacıoğlu ŞK, Emektar E, Çevik Y. The effects of spinal immobilization at 20° on intracranial pressure. Am J Emerg Med 2019; 37:1327-30. [PMID: 30327158 DOI: 10.1016/j.ajem.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/10/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE In this study, it was aimed to evaluate whether spinal immobilization at 20°, instead of the traditional 0°, affects intracranial pressure (ICP) via the ultrasonographic (USG) measurement of optic nerve sheath diameter (ONSD). METHODS 140 healthy, adult, non-smoking volunteers who had no acute or chronic diseases were included this study. Volunteers were randomly divided into two groups; performed spinal immobilization at 0° (Group 1) and at 20° (Group 2). After spinal immobilization (at 0 or 20°), measurements of ONSD were performed at 0, 30, and 60 min in an immobilized position. RESULTS When evaluating the change in ONSD over time (at 30 and 60 min) as compared to basal measurements at 0 min, it was found that the ONSD values of both sides (the right and left eyes) were significantly increased in Group 1 and Group 2. For Groups 1 and 2, these differences existed both between 0 and 30 min and between 30 and 60 min. In addition, in this study, the amounts of increase in the ONSD measurements from 0 to 30 min and from 30 to 60 min (ΔONSD0-30 min and ΔONSD30-60 min) in both groups were compared. The results showed that there was no significant difference between Group 1 and Group 2 in terms of ΔONSD measurements. CONCLUSIONS Spinal immobilization at 0° as a part of routine trauma management increased ONSD and thus ICP. Secondly, we found that similar to immobilization at 0°, spinal immobilization at 20° increased ONSD.
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Larson S, Delnat AU, Moore J. The Use of Clinical Cervical Spine Clearance in Trauma Patients: A Literature Review. J Emerg Nurs 2017; 44:368-374. [PMID: 29203049 DOI: 10.1016/j.jen.2017.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 10/11/2017] [Accepted: 10/21/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Five million patients in America are placed in spinal immobilization annually, with only 1% to 2% of these patients suffering from an unstable cervical spine injury. Prehospital agencies are employing selective and limited immobilization practices, but there is concern that this practice misses cervical spine injuries and therefore possibly predisposes patients to worsening injuries. METHODS A systematic review was conducted that examined literature from the last 5 years that reviewed cervical spine immobilization application and/or clearance in alert trauma patients. RESULTS Prehospital selective immobilization protocols and bedside clinical clearance examinations are becoming more commonplace, with few missed injuries or poor outcomes. Prehospital providers can evaluate patients in the field safely to assess who needs or does not need cervical collars; similar criteria can be used in the emergency department. Harm from cervical collars is increasingly documented, with concerns that risks exceed possible benefits. DISCUSSION The literature suggests that alert trauma patients can be cleared from cervical spine immobilization safely through a structured algorithm in either the prehospital or ED setting. The evidence is primarily observational. Thus, many providers who fear missing cervical injuries may be reluctant to follow the recommendations despite few or no published cases of sudden deterioration from missed cervical spine injuries.
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Mok JM, Jackson KL, Fang R, Freedman BA. Effect of vacuum spine board immobilization on incidence of pressure ulcers during evacuation of military casualties from theater. Spine J 2013; 13:1801-8. [PMID: 23816354 DOI: 10.1016/j.spinee.2013.05.028] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 03/05/2013] [Accepted: 05/04/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT In the summer of 2009, the vacuum spine board (VSB) was designated by the US Air Force as the preferred method of external spinal immobilization during aeromedical transport of patients with suspected unstable thoracolumbar spine fractures. One purported advantage of the VSB is that, by distributing weight over a larger surface area, it decreases the risk of skin pressure ulceration. PURPOSE To examine whether the rate of pressure ulcers has changed since the introduction of the VSB. STUDY DESIGN Retrospective cohorts. PATIENT SAMPLE Injured US service members undergoing spinal immobilization during evacuation from the Iraq and Afghanistan theaters to Landstuhl, Germany. OUTCOME MEASURES Presence and stage of pressure ulceration, and deterioration in neurologic status. METHODS Records of the initial 60 patients medically evacuated on the VSB to Landstuhl Regional Medical Center were retrospectively analyzed for patient demographics, injury characteristics, and incidence of pressure injury. The incidence of pressure ulcers after the use of VSB was compared with that in a historical control consisting of 30 patients with unstable spinal injuries evacuated before the introduction of the VSB. No sources of external funding were used for this investigation. RESULTS The combined cohort had a mean age of 28.8 years and mean Injury Severity Score (ISS) of 20.63 and comprised 96% men. Most injury mechanisms were blunt (58%). The rate of neurological injury was 19%. There were no cases of progressive neurological deficit or deformity in either cohort. In the VSB group, using a broad definition of pressure ulcer, incidence was 13 of 60 patients (22%). Using a strict definition, incidence was eight of 60 (13%): five Stage I and three Stage II. In the non-VSB group, incidence of pressure ulcers was three of 30 (10%), using either definition, all Stage II. Difference in incidence between the groups was not statistically significant. Intubated patients had a significantly higher incidence of pressure ulcers. CONCLUSION Both the VSB and historic means (non-VSB) of spinal immobilization appear to be safe and produce only transient morbidity despite an average of 9 to 10 hours of transport. Intubated status was identified as the most important risk factor for the development of a pressure ulcer.
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Affiliation(s)
- James M Mok
- Orthopaedic Surgery Service, Department of Surgery, Madigan Army Medical Center, Bldg 9040A Fitzsimmons Dr, Tacoma, WA 98431, USA.
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