StudentShare
Contact Us
Sign In / Sign Up for FREE
Search
Go to advanced search...
Free

Does a Cervical Collar Immobilization Device Improve Patient Outcomes - Research Paper Example

Cite this document
Summary
The paper "Does a Cervical Collar Immobilization Device Improve Patient Outcomes?" focuses on the critical analysis of whether a cervical collar immobilization device improves patient outcomes. Spinal immobilization is an effective strategy to prevent further injury to the spine and spinal cord…
Download full paper File format: .doc, available for editing
GRAB THE BEST PAPER93.4% of users find it useful
Does a Cervical Collar Immobilization Device Improve Patient Outcomes
Read Text Preview

Extract of sample "Does a Cervical Collar Immobilization Device Improve Patient Outcomes"

?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. Especially the cervical spine is prone for further injury because of movements of the head and the most common practice is to immobilize cervical spine is using a cervical collar. Though several devices and techniques are being developed for cervical immobilization, it is yet unclear whether use of cervical collar during resuscitation and transport improves patient outcomes. 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 backboard to secure the whole body including the trunk is superior to cervical collar immobilization alone. Chandler et al (p.1185) conducted a study to evaluate the effectiveness of immobilization of cervical-spine using a rigid cervical extrication collar and an Ammerman halo orthosis with and without spine boards. Their study included 20 normal men and the measurements used to examine were photographic measurement of head and neck during maximal movements and radiological measurement during flexion-extension. From the results of the study, it was evident that immobilization was much better with spine board and a rigid cervical collar rather than cervical collar alone. Similar opinion was provided by Hauswald et al (AANS, p.6) who also reported in their prospective study that vacuum splint device was much faster to apply than the spine boards and that it was much better in immobilizing head. In yet another study, Hamilton et al (AANS, p.6) reported that vacuum splint device had similar advantages and disadvantages compared to backboard-collar combination. According to Webber-Jones (p.19), rigid cervical collar is one of the good additions for successful treatment of injuries related to cervical spine. However, they are fraught with several disadvantages like providing a false sense of security in terms of complete prevention of further spinal damage. The increased length of wear of collar causes development of skin pressure points leading to pressure ulcers. The ulcers delay weaning from ventilators and increase the risk of exposure to blood borne diseases. In yet another study by Gennis (p.568), the researchers conducted a randomized controlled trial in an emergency department in an urban setting. Adult patients with neck pain following automobile involved road traffic accidents, but without obvious cervical spine injury like focal neurologic deficits, cervical spine fractures, cervical spine subluxation and major distraction injuries were assigned to receive soft cervical collar or no collar based on random assignment. The patients were evaluated after 6 weeks in terms of pain based on the visual analogue scale. From the results of the study it was evident that there was no difference between the study group and control group in terms of recovery, improvement or deterioration. The authors opined that soft collar application has no role in the improvement of pain in those with whiplash injury. After the introduction of immobilization of spine a routine in the protocols of all emergency medical services, the rates of complications related to cervical cord damage have been significantly reduced (AANS, p.3). However a study by Hauswald et al (cited in AANS, p.7) disputed this fact. In their study, they found that outcomes were similar in those who were immobilized with cervical collar and those who were not, in patients who suffered from road traffic blunt injury. In fact, they noted that those who did not receive cervical collar immobilization had less neurological consequences that those who were immobilized. The authors theorized that when the initial injury itself is of tremendous force, subsequent immobilization with collar is insufficient to cause further injury48. But this study has been challenged and several flaws have been identified like died patients excluded from the study and lack of matching of injuries based on the severity of neurological injuries. It is not possible to execute a clinical trial to ascertain the benefits of cervical spine immobilization owing to ethical and legal issues. The consensus opinion in articles reviewed is that from an biomechanical and anatomic perspective and also from time-tested clinical perspective, in patients with established or potential cervical spine injuries, spinal column immobilization must be done until definitive management or exclusion of injury. Following Hauswald's report, several experts have opined that cervical immobilization must be executed only in those with high risk for cervical injury. The benefits of a such a protocol was studied by Domier et al (p.332). These researchers studied 6500 trauma patients in which they immobilized patients base don clinical criteria like focal neurologic deficit, altered mental status, intoxication, spinal tenderness, spinal pain and suspected extremity fracture.,the authors opined that clinical criteria is a better tool to ascertain and predict the need for cervical immobilization rather than the mechanism of injury. In a major study by Podolsky et al (p.77), the researchers evaluated the efficacy of the immobilization techniques of cervical spine through goniometric measures. From the results of the study, it was evident that cervical collars alone are not useful for cervical spine immobilization and that sand bags taped in proper position are also essential. In another study by Cline (1985) (p.18), the researchers opined that short boards were superior to cervical collar for immobilization of cervical spine. Application of cervical collar is fraught with certain disadvantages. According to Chan et al (16), those whose cervical spine was immobilized suffered from pain and discomfort and other symptoms like sacral pain, mandibular pain, lumbar pain and occipital head ache. Cervical collars are also associated with elevations in the intracranial pressure and risks of aspiration. (AANS, p.10). In conclusion, it can be inferred that cervical collars in trauma patients are generally effective for limiting the motion of the cervical spine, but are associated with modest morbidity. They should be used for safe extrication and transit, but must be removed as soon as possible. Works Cited Page AANS.Prehospital immobilisation following trauma September 2001. 25th April 2011. Web Chan D, Goldberg R, et al. "Backboard versus mattress splint immobilization: a comparison of symptoms generated." J Emergency Med. 1996, 14:293-298. Chandler, DR., Nemejc, C, Adkins, RH., and Waters, RL. “Emergency cervical-spine immobilization.” Ann Emerg Med., 1992, 21(10), 1185-8. Cline JR, Scheidel E, et al. "A comparison of methods of cervical immobilization used in patient extrication and transport." J Trauma, 1985, 25:649-653. Domeier RM, Evans RW, et al. "The reliability of pre-hospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury." Pre-Hospital Emergency Care, 1999, 3:332-337. Gennis P, Miller L, Gallagher EJ, Giglio J, Carter W, Nathanson N. "The effect of soft cervical collars on persistent neck pain in patients with whiplash injury." Acad Emerg Med., 1996, 3(6):568-73. Jin P, Goslings J, Luitse J, & Ponsen K. "A retrospective study of five clinical criteria and one age criterion for selective prehospital spinal immobilization." European Journal of Trauma & Emergency Surgery, 2007, 33(4), 401-406. Krock, N. "Immobilizing the cervical spine using a collar. Complications and nursing management." Axone, 1997, 18(3), 52-5. Podolsky S, Hoffman, JR, et al. "Neurologic complications following immobilization of cervical spine fracture in a patient with ankylosing spondylitis." Ann Emerg Med, 1983, 12:578-580. Schnabel, M, Ferrari, R, Vassiliou, T, and Kaluza, G. "Randomised, controlled outcome study of active mobilisation compared with collar therapy for whiplash injury." Emerg Med J., 2004, 21, 306–310. Webber-Jones JE, Thomas CA, Bordeaux RE Jr." The management and prevention of rigid cervical collar complications." Orthop Nurs. 2002 Jul-Aug;21(4):19-25 Read More
Cite this document
  • APA
  • MLA
  • CHICAGO
(“Does a cervical collar immobilization device improve patient outcomes Research Paper”, n.d.)
Retrieved from https://studentshare.org/family-consumer-science/1418612-does-a-cervical-collar-immobilization-device
(Does a Cervical Collar Immobilization Device Improve Patient Outcomes Research Paper)
https://studentshare.org/family-consumer-science/1418612-does-a-cervical-collar-immobilization-device.
“Does a Cervical Collar Immobilization Device Improve Patient Outcomes Research Paper”, n.d. https://studentshare.org/family-consumer-science/1418612-does-a-cervical-collar-immobilization-device.
  • Cited: 0 times

CHECK THESE SAMPLES OF Does a Cervical Collar Immobilization Device Improve Patient Outcomes

Spinal immobilization

However, from whatever results are available, it appears that a combination of cervical collar immobilization with supportive straps on a rigid long spinal backboard to secure the whole body including the trunk is superior to cervi... 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.... According to Cline (1985; cited in AANS, 2001 ), short boards are superior to cervical collar alone....
4 Pages (1000 words) Research Paper

Cervical Spine Injury

In these types of injuries it is common to find two situations: one where the patient is complaining of neck pain and thus can alert rescuers and second where the patient remains unconscious and cannot alert rescuers and this puts them in a vulnerable position (Timothy, 2004, p.... The spinal immobilization devices that are used by the rescuers consist of a hard collar with supports on either side of the head and the patient lying on a spine board with the head strapped on the board with the neck in a neutral position....
4 Pages (1000 words) Essay

Therapeutic Hypothermia Impacts of Neurological Function of Post Cardiac Arrest Patients

hellip; The use of therapeutic hypothermia to assist patient recover from the post cardiac arrest effects have been extensively studied and established.... Cardiac arrest is one of the medical conditions, which are known to result into low or insufficient blood flow into the body of a patient.... The induction phase enables the attainment of a patient's target body temperature within the shortest time possible....
17 Pages (4250 words) Research Paper

The use of spinal immobilisation in the prehospital environment An investigative study

In addition it stresses that "cervical spine injury requires continuous immobilization of the entire patient with a semi-rigid cervical collar, backboard, tape and straps before and during transfer to a definite-care facility".... Even the manual of the ATLS does not make a distinction between blunt and penetrating neck trauma, generally stating that "any patient with a suspected spine injury must be immobilized above and below the suspected injury site until injury has been excluded by roentgenograms"....
13 Pages (3250 words) Essay

The DCMT Long Spine Board Immobilization Standard

The current model in the medical field is to design a challenging curriculum, develop courses, teaching and guiding learners, clinical trials, and finally evaluating along with documenting the outcomes.... The assistant EMT controlled the head and the cervical spine while the student had to move the patient to the device.... After that, the student with the help of the administrator and the EMT moved the patient to keep him intact.... After that check, the board was placed underneath the patient with the assistance of administrator and the EMT....
2 Pages (500 words) Essay

Mandating Nurse-Patient Ratios

itle of Source, URL and author: The first work titled “The effect of nurse staffing on selected outcomes of care” is a 2008 publication found on the ProQuest online database.... As a ult, experts in healthcare have argued that in order to better safety of patients and quality of care there needs to be a higher number of nurses so as to lower the nurse-to-patient ratio (NPR), which will ensure nurses have more time with patients, which will ensure quality care and assessment-which are contributing factors to enhancing quality and safety of care....
6 Pages (1500 words) Coursework

Respiratory Muscle Training for Cervical Spinal Cord Injury

The essay will focus on a number of training procedures that are aimed at assisting those patients with Several articles would be used as a way of finding conclusive statement that would be aimed to be a solution to the several problems associated with patient with spinal cord injuries.... he other methodology applied in training of patient with spinal cord injury is use of simple breathing device.... The mode of training will involve inspirational training at low loads which would indicate the patient being subjected to conditions of about 30 percent of MIP (Silveira et al, 2010 P 317)....
4 Pages (1000 words) Essay

Developing a Prehospital/Paramedic CPI for Spinal Cord Injury

The value of clinical performance indicators or CPIs lies in their ability to shore up services quality as well as to provide metrics for measuring the quality of services and other relevant indicators in healthcare, with the goal of improving care and patient outcomes in the long term.... hellip; The aim is the development of a CPI for spinal cord injury that will form a foundation for standardizing procedures and protocols for dealing with situations involving the condition and with an eye towards improving care and outcomes through the provision of standards that can form the basis of metrics for measuring improvements to the services....
12 Pages (3000 words) Essay
sponsored ads
We use cookies to create the best experience for you. Keep on browsing if you are OK with that, or find out how to manage cookies.
Contact Us