Efficacy of Cervical Spine Immobilization Methods

Value of a rigid collar in addition to head blocks: a proof of principle study

“…More than five million patients require spinal immobilisation each year 3. From a trial in 1983 it was concluded that the combination of a rigid collar with sandbags and tape was most effective in immobilisation of the cervical spine 4. In the 1990s, the sandbags and tape were replaced by foam head blocks strapped to padded backboards.…”

A reply

“…Most importantly it underlines the use of clinical judgement in assessing the need for immobilisation, irrespective of the X ray findings. When cervical spine immobilisation is required, the method taught by ATLS, sandbags, semirigid collar and forehead tape, has been proven to be the most effective method [3]. The alleged lack of clarity on manual inline immobilisation arises since, when teaching practical skills, the ATLS course relies on small group teaching at skill stations, at which such a technique would be described and demonstrated, not on written descriptions.…”

“…Its merits in trauma, relative to oral intubation, have been reviewed by Stene et al [6]. In a UK trauma study, acute hypoxia was a significant factor in 13% (22/170) of preventable in-hospital deaths [3]. Pulmonary aspiration occurred in 15 of these 22 cases.…”

A reply

“…Propofol is an effective anticonvulsant [I, 21, which may rarely be associated with excitatory phenomena, including epileptiform seizures [3]. A recent publication by the U K Committee on Safety of Medicines (CSM) [4] highlighted 170 reports of generalised convulsions, myoclonus or opisthotonus following the administration of propofol on an estimated 8 000 000 occasions for general anaesthesia or ITU sedation.…”