Skin necrosis caused by a semi-rigid cervical collar in a ventilated patient with multiple injuries

Abstract

A I9-year-old girl was involved in a road traffic accident and was trapped in her car sustaining multiple injuries. A two piece semi-rigid collar was applied at the scene. She was managed according to Advanced Trauma Life Support protocols by an Accident Flying Squad. Her injuries consisted of a tear in the small bowel mesentery requiring emergency surgery for haemorrhage, cerebral oedema, fractures of the left acetabulum and left twelfth rib, and pulmonary contusions. The initial cervical spine radiograph failed to include C7 Tl and therefore the collar was left on. She had a persistent tachycardia of around lOO/min and one brief hypotensive episode (80 mmHg systolic) prior to theatre, which responded rapidly to fluid resuscitation. Total volume resuscitation consisted of 2 litres of colloid and 4 units of blood. After theatre and computerized tomographic scan she was ventilated on the intensive care unit. The following day further radiographs of the cervical spine were performed and reported as normal. The collar was removed 36 h after its application, at which time areas of skin necrosis were noted over the angles of the jaw (Figure 7) and indentations in the skin of the occiput and chest.