Cervical Spine Immobilization of Penetrating Neck Wounds in a Hostile Environment

Arishita, Gary; Vayer, Joshua S.; Bellamy, Ronald F.

doi:10.1097/00005373-198903000-00009

Cited by 69 publications

(27 citation statements)

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“…Appeared a likely source of this increased risk of indirect central neurologic injury. CSI iatrogenia may have facilitated indirect neurologic injury by negatively impacting the "ischemic penumbra" [2][3][4][5][6]15,[22][23][24]27,29,30].…”

Section: Discussionmentioning

confidence: 99%

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Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Turnock¹,

Carney²,

Fleischer³

et al. 2016

Trauma Emerg Care

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This study hypothesized that cervical spine immobilization (CSI) in penetrating cervical trauma is associated with increased central neurologic injury rather than prevention. Data abstraction proceeded from a previously constructed patient database formed via retrospective chart analysis of the trauma registries of two independent American College of Surgeons verified Level 1 Trauma centers. Neurologic injuries were categorized as peripheral or central. Central neurologic injuries were further subdivided into spinal cord and brain injuries. Patients were grouped according to the presence and type of neurologic injury, the presence and type of cervical spine fracture, death, and the presence or absence of respiratory and vascular injury. Vascular injury was further subdivided into major and minor categories. Groups were compared statistically. Significance was accepted for p<0.05. Cervical spine fracture (CSFx) was a significant risk factor for cervical spinal cord injury (CSCI) (p<0.00001; RR 20.56; 95% CI 8.44-26.47) but all patients with unstable CSFx presented with complete spinal neurologic devastation. Major vascular injury was associated with brain injury (p=0.01; RR 10.21; 95% CI 6.67-15.65) but was not associated with CSCI (p=0.99) or CSFx (p=0.67). Hypoperfusion was a strong independent risk cervical cord and brain injury (p<0.00001; RR 38.4; 95% CI 16.17-91.2). CSI was a significant risk factor for indirect central neurologic injury (p<0.001; RR 1.63; 95% CI 1.23-1.95). Brain injury was not associated with CSFx (p=0.35) or CSCI (p=0.08). No benefit of CSI in penetrating cervical trauma could be determined from this study. CSI entailed an absolute risk increase for central neurologic injury of 18.69% with a 5.3 number needed to harm (NNH).

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Section: Discussionmentioning

confidence: 99%

“…Transport delays for CSI vary from an average of 8-30 mins [23,24]. Average total field times are reduced 34% from 46-20 mins by initiation of a "scoop and run" policy [24].…”

Section: Introductionmentioning

confidence: 99%

Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Turnock¹,

Carney²,

Fleischer³

et al. 2016

Trauma Emerg Care

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“…2 When a patient requires manual manoeuvre to open the airway, the most appropriate methods must be determined. Of the three generally accepted manoeuvres, only two are acceptable to trauma patients 3 (head tilt manoeuvre should be avoided).…”

Section: Basic Airway Managementmentioning

confidence: 99%

Airway Management in Trauma

2015

IJAA

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The treatment of the seriously injured patient requires rapid assessment of the injuries and institution of lifepreserving therapy. Inadequate delivery of oxygenated blood to the brain and other vital structures is the quickest killer of the injured. Ensuring an unobstructed airway and adequate oxygenation are first priorities in the resuscitation of the trauma patient. Unlike the elective surgical patient the trauma patients present many challenges (Figure 1).A diverse array of equipment and skills are necessary for optimal airway management. AbstractAirway Management for the victims of major trauma is the first priority in the care of the trauma victim and is a core skill in emergency medicine and critical care. Endotracheal intubation remains the gold standard for trauma airway management. Airway management in trauma patients is not just the capability to insert an oral/nasal airway or endotracheal tube beyond the vocal cords. The five components integral to modern, sophisticated airway management in trauma patients include equipment, pharmacologic adjuncts, manual techniques, physical circumstances, and patient profile. A trauma patient may require airway management in a variety of physical circumstances. Whereas, the commonly used airway management algorithms may not suffice in all these situations, the construction of a truly complete decision tree is also virtually impossible. There is consensus that it is not the intervention per se but rather the conditions, skills, and performance that might be the possible variables that affect outcome. Paramedics have only limited experience and on-the-job skills for invasive airway management. Difficult airway management is best left for the experienced physicians to handle.

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“…However, there are significant obstacles to spinal immobilization on the battlefield. It takes 2 prehospital care providers an average of 5 minutes to immobilize a casualty, 23 requiring a significant equipment load that simply cannot be carried easily into combat. Arishita and colleagues 23 reviewed data from the Vietnam War and discovered that 10% of casualties occurred during the treatment of other casualties and that only 1.4% of penetrating neck injuries may have benefited from spinal immobilization.…”

Section: Lessons Learnedmentioning

confidence: 99%

“…It takes 2 prehospital care providers an average of 5 minutes to immobilize a casualty, 23 requiring a significant equipment load that simply cannot be carried easily into combat. Arishita and colleagues 23 reviewed data from the Vietnam War and discovered that 10% of casualties occurred during the treatment of other casualties and that only 1.4% of penetrating neck injuries may have benefited from spinal immobilization. Similar findings have been reported in studies of pene trating neck injuries in civilians 24 and in UK casualties in Afghanistan.…”

Section: Lessons Learnedmentioning

confidence: 99%

Tactical Combat Casualty Care in the Canadian Forces: lessons learned from the Afghan war

Savage

Forestier²,

Withers³

et al. 2011

Can J Surg

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Cervical Spine Immobilization of Penetrating Neck Wounds in a Hostile Environment

Cited by 69 publications

References 0 publications

Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Cervical spine immobilization in penetrating cervical trauma is associated with an increased risk of indirect central neurological injury

Airway Management in Trauma

Tactical Combat Casualty Care in the Canadian Forces: lessons learned from the Afghan war

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