Effects of spinal immobilization at 20° on respiratory functions

Effects of Spinal Immobilization with Backboard at 20 Degrees on Pain and Discomfort Levels

BACKGROUND

Although spinal immobilization (SI) in the form of reverse Trendelenburg at a 20-degree angle has been shown to reduce undesirable side effects, such as decreased respiratory function seen with 0-degree SI, concerns exist that SI at 20 degrees might increase pain and discomfort, particularly in the lower body, because of gravity.

OBJECTIVE

This study aims to evaluate whether SI at a 20-degree angle results in different levels of pain and discomfort in various body regions compared to SI at a 0-degree angle.

METHODS

This experimental study was conducted with healthy adult volunteers aged 25 to 45 years who had no chronic illnesses or obesity (body mass index <30). Each volunteer underwent two separate immobilization sessions on different days: once at a 0-degree angle (0-degree group) and once at a 20-degree angle (20-degree group), each lasting 1 hour. Vital signs and pain/discomfort levels by visual analog scale (VAS) were recorded at baseline, 15, 30, and 60 min.

RESULTS

A total of 51 volunteers participated in the study. While a statistically significant increase in pain and discomfort was observed over time in both the 0-degree and 20-degree groups, no statistically significant difference in VAS scores was found between the two groups at any time point.

CONCLUSION

Although SI at a 20-degree angle does not reduce the pain and discomfort associated with the 0-degree position, it also does not increase these symptoms.

European Resuscitation Council Guidelines 2021: First aid

The European Resuscitation Council has produced these first aid guidelines, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics include the first aid management of emergency medicine and trauma. For medical emergencies the following content is covered: recovery position, optimal positioning for shock, bronchodilator administration for asthma, recognition of stroke, early aspirin for chest pain, second dose of adrenaline for anaphylaxis, management of hypoglycaemia, oral rehydration solutions for treating exertion-related dehydration, management of heat stroke by cooling, supplemental oxygen in acute stroke, and presyncope. For trauma related emergencies the following topics are covered: control of life-threatening bleeding, management of open chest wounds, cervical spine motion restriction and stabilisation, recognition of concussion, cooling of thermal burns, dental avulsion, compression wrap for closed extremity joint injuries, straightening an angulated fracture, and eye injury from chemical exposure.

Philadelphia versus Miami-J cervical collar's impact on pulmonary function

PURPOSE

The purpose of this study was to compare the effect of two types of cervical collars (Philadelphia and Miami-J) on pulmonary function and ventilation in healthy volunteers through spirometry, peak flow meter, and capnograph.

METHOD

Initially, subjects were randomized into two groups in which the sequence of collars' fixation was reversed. Afterward, we assessed the pulmonary parameters without a cervical collar in all participants. Each group underwent two additional test conditions, including measurements after wearing a Philadelphia and Miami-J cervical collar. In any case, we took the measurements half an hour after the collar fixation.

RESULTS

The mean age of participants was 48.34 ± 1.35 years. Following either type of collars application, there was a statistically significant decrease in FEV1, FEV1/FVC, FEF25-75%, and PEF (p < .001). However, FVC was not significantly changed (p = .157).

CONCLUSION

In summary, we noted a statistically significant expiratory flow obstruction after both the Philadelphia and Miami-J cervical collar. These changes were not clinically significant in healthy volunteers, albeit may have ramifications in patients with pre-existing respiratory compromise.

Evidence-Based Nursing Care for Spinal Nursing Immobilization: A Systematic Review

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.

The Effects of Positional Change on Hemodynamic Parameters in Spinal Immobilization

INTRODUCTION

The use of a long backboard and cervical collar are commonly recommended by international guidelines for spinal immobilization, but both devices may cause several side effects. In a recent study, it was reported that spinal immobilization at 20° eliminated the decrease in pulmonary function secondary to spinal immobilization performed at 0°. Spinal immobilization at 20° is a new recommendation, but other potential effects need to be explored before it can be implemented in clinical use.

STUDY OBJECTIVE

Hemodynamic observation is important in the management of trauma patients. The aim of this study was to investigate the effect of spinal immobilization at a 20° position instead of 0° on hemodynamic parameters.

METHODS

This study included 53 healthy volunteers who underwent spinal immobilization in the supine position (00) and in an elevated position (200). Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), left ventricular outflow tract velocity time integral (LVOT-VTI), left ventricular stroke volume (LVSV), cardiac output (CO), inferior vena cava diameter inspiration (IVC diameter insp), IVC diameter expiration (IVC diameter exp), and inferior vena cava collapsibility index (IVC-CI) were measured at the 0th and 30th minutes of spinal immobilization in both positions. The data were compared for demonstrating the efficiency of both positions in spinal immobilization.

RESULTS

A statistically significant difference was found in the parameters of the IVC diameter (exp), IVC diameter (insp), LVOT-VTI, LVSV, and CO through the measurements starting in the 0th minute of the transition from 0° to 20° (P <.001). Delta values (∆) of hemodynamic parameters (∆IVC diameter [exp], ∆IVC diameter [insp], ∆LVOT-VTI, ∆SV, ∆CO, ∆IVC-CI, ∆MAP, ∆SAP, ∆DAP, and ∆HR) were similar in spinal immobilization at 0° and 20°.

CONCLUSION

The findings obtained from this study illustrate that spinal immobilization at 20° does not cause clinically significant hemodynamic changes in healthy subjects compared to spinal immobilization at 0°.

Effects of spinal immobilization at 20° on end-tidal carbon dioxide

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.

Analysis of cervical spine immobilization during patient transport in emergency medical services

PURPOSE

It remains controversial how to immobilize the cervical spine (CS) in trauma patients. Therefore, we analyzed different CS immobilization techniques during prehospital patient transport.

METHODS

In this explorative, biomechanical analysis of immobilization techniques conducted in a standardized setting, we recorded CS motion during patient transport using a wireless human motion tracker on a volunteer. To interpret spinal movement a benchmark called motionscore (MS) was developed based on biomechanics of the injured spine.

RESULTS

We found the best spinal motion restriction using a spine board, head blocks and immobilization straps with and without a cervical collar (CC) (MS 45 vs. 27). Spinal motion restriction on a vacuum mattress with CC and head blocks was superior to no CC or head blocks (MS 103 vs. 152). An inclined vacuum mattress was more effective with head blocks than without (MS 124 vs. 187). Minimal immobilization with an ambulance cot, CC, pillow and tape was slightly superior to a vacuum mattress with CC and head blocks (MS 92 vs. 103). Minimal immobilization without CC showed the lowest spinal motion restriction (MS 517).

CONCLUSIONS

We suggest an immobilization procedure customized to the individual situation. A spine board should be used whenever spinal motion restriction is indicated and the utilization is possible. In some cases, CS immobilization by a vacuum mattress with CC and head blocks could be more beneficial. In an unstable status of the patient, minimal immobilization may be performed using an ambulance cot, pillow, CC and tape to minimize time on scene caused by immobilization.

The effects of spinal immobilization at 20° on intracranial pressure

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.