Effects Of Spinal Immobilization Research Articles

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

ObjectiveThe 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. MethodsThe 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. ResultsThere 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. ConclusionConventional 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.

Effects of Spinal Immobilization and Spinal Motion Restriction on Head-Neck Kinematics during Ambulance Transport

Objective: To determine the influence of ambulance motion on head-neck (H-N) kinematics and to compare the effectiveness of two spinal precaution (SP) protocols: spinal immobilization (SI) and spinal motion reduction (SMR). Methods: Eighteen healthy volunteers (7 females) underwent a series of standardized ambulance transport tasks, across various speeds, under the two SP protocols in a balanced order (n = 12 drivers, n = 7 ambulances). Inertial measurement units were placed on participants’ heads and sternums, with another affixed to the stretcher mattress frame. Outcome measures included H-N displacement and acceleration. Results: Ambulance accelerations varied across driving tasks (2.5–9.5 m/s2) and speeds (3.0–6.2 m/s2) and resulted in a wide range of H-N displacements (7.2–22.6 deg) and H-N accelerations (1.4–10.9 m/s2). Relative to SMR, SI resulted in reduced H-N motion during turning, accelerating, and speed bumps (1.9–10.7 deg; 0.4–2.6 m/s2), but increased H-N accelerations during abrupt starts/stops and some higher speed tasks (0.4–2.5 m/s2). Ambulance acceleration was moderately correlated to H-N acceleration (r = 0.68) and displacement (r = 0.42). Conclusion: H-N motion was somewhat coupled to ambulance acceleration and varied across a wide range, regardless of SP approach. In general, SI resulted in a modest reduction in H-N displacement and acceleration, with some exceptions. The results inform clinical decisions on SP practice during prehospital transport and demonstrate a novel approach to quantifying H-N motion in prehospital care.

The effects of spinal immobilization at 20° on intracranial pressure

ObjectiveIn 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). Methods140 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. ResultsWhen 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. ConclusionsSpinal 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.

Effects of spinal immobilization at a 20° angle on cerebral oxygen saturations measured by INVOS™

Background and aim of the studyIn this study, we aimed to investigate whether performing the immobilization at 20° instead of 0° changes cerebral oxygenation. Materials and methods33 volunteers were put in a hard cervical collar and backboard at 0° and immobilized for 30min. The cerebral oxygen saturations of the volunteers were measured at 1, 5, and 30min after the start of the procedure (Group 1). The volunteers were asked to return the day after the Group 1 procedure but at the same time. Serial cerebral oxygen saturations were obtained at the same time intervals as in Group 1, but for Group 2, the backboard was set to 20°. ResultsWhen the cerebral oxygen saturations of the two groups were compared, there was a slight decrease when the backboard position was changed from 0° to 20°, but it was not statistically significant (P=0.220 and P=0.768, respectively). The results revealed that immobilizing the patients with a spinal backboard at 20° instead of 0° did not alter the cerebral oxygen saturations. ConclusionOur study results revealed that spinal immobilization at 20°, which was a new suggestion for spinal immobilization following a report that this position reduced the decrease in pulmonary function secondary to spinal immobilization, did not alter the cerebral oxygenation, so this suggestion is safe at least from the standpoint of cerebral oxygenation.

Effects of spinal immobilization at 20° on respiratory functions

PurposeThe purpose of the study is to investigate whether spinal immobilization with a long backboard (LBB) and semirigid cervical collar (CC) at 20° instead of 0° conserve pulmonary functions, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. MethodologyThe study included 56 adult healthy volunteers. Volunteers were randomly divided into 2 groups, and those in the first group (group 1) had LBBs and CCs applied at 0° (n=30), whereas volunteers in the second group (group 2) had LBBs and CCs applied at 20° (n=26). All volunteers were given pulmonary function tests, which included FEV1 and FVC levels and FEV1/FVC ratios, while in the sitting position. Measurements were repeated at 0, 5, and 30 minutes. ResultsResults showed significant decreases in FEV1 and FVC values and FEV1/FVC ratios in group 1 and significant decreases in FEV1 values and FEV1/FVC ratios in group 2 (P<.001). However, FVC values were not decreased in group 2 when compared to basal levels taken while in a sitting position (P=.45). In addition, the study evaluated the amounts of decrease in the FEV1 and FVC levels and the FEV1/FVC ratios (ΔFEV1, ΔFVC, and ΔFEV1/FVC ratio). Results showed that ΔFEV1 values compared to basal levels and levels at 0, 5, and 30 minutes were all lower in group 2 than in group 1. However, ΔFEV1/FVC ratios were similar in both groups. ConclusionThe results of this and previous studies have shown that traditional spinal immobilization decreases respiratory function, whereas using spinal immobilization at 20° can reduce this decrease in function.

Effect of Spinal Immobilization with a Long Backboard and Cervical Collar on the Vital Signs

Effect of Spinal Immobilization with a Long Backboard and Cervical Collar on the Vital Signs

The Prehospital Management of Suspected Spinal Cord Injury: An Update

Spinal cord injury (SCI) is a serious condition that may lead to long-term disabilities placing financial and social burden on patients and their families, as well as their communities. Spinal immobilization has been considered the standard prehospital care for suspected SCI patients. However, there is a lack of consensus on its beneficial impact on patients' outcome. This paper reviews the current literature on the epidemiology of traumatic SCI and the practice of prehospital spinal immobilization. A search of literature was undertaken utilizing the online databases Ovid Medline, PubMed, CINAHL, and the Cochrane Library. The search included English language publications from January 2000 through November 2012. The reported annual incidence of SCI ranges from 12.7 to 52.2 per 1 million and occurs more commonly among males than females. Motor vehicle collisions (MVCs) are the major reported causes of traumatic SCI among young and middle-aged patients, and falls are the major reported causes among patients older than 55. There is little evidence regarding the relationship between prehospital spinal immobilization and patient neurological outcomes. However, early patient transfer (8-24 hours) to spinal care units and effective resuscitation have been demonstrated to lead to better neurological outcomes. This review reaffirms the need for further research to validate the advantages, disadvantages, and the effects of spinal immobilization on patients' neurological outcomes.

The Effect of Spinal Immobilization on Vital Signs

The Effect of Spinal Immobilization on Vital Signs

Effect of Spinal Immobilization on Heart Rate, Blood Pressure and Respiratory Rate

Vital signs remain important clinical indicators in the management of trauma. Tissue injury and ischemia cause tachycardia and hypertension, which are mediated via the sympathetic nervous system (SNS). Spinal immobilization is known to cause discomfort, and it is not known how this might influence the SNS and contribute to abnormal vital signs. Hypothesis This study aimed to establish whether the pain and discomfort associated with spinal immobilization and the maneuvers commonly used in injured patients (eg, log roll) affect the Heart rate (HR), Systolic Blood Pressure (SBP) and Respiratory rate (RR). The null hypothesis was that there are no effects. A prospective, unblinded, repeated-measure study of 53 healthy subjects was used to test the null hypothesis. Heart rate, BP and RR were measured at rest (five minutes), after spinal immobilization (10 minutes), following log roll, with partial immobilization (10 minutes) and again at rest (five minutes). A visual analog scale (VAS) for both pain and discomfort were also collected at each stage. Results were statistically compared. Pain VAS increased significantly during spinal immobilization (3.8 mm, P < .01). Discomfort VAS increased significantly during spinal immobilization, after log roll and during partial immobilization (17.7 mm, 5.8 mm and 8.9 mm, respectively; P < .001). Vital signs however, showed no clinically relevant changes. Discussion Spinal immobilization does not cause a change in vital signs despite a significant increase in pain and discomfort. Since no relationship appears to exist between immobilization and abnormal vital signs, abnormal vital signs in a clinical situation should not be considered to be the result of immobilization. Likewise, pain and discomfort in immobilized patients should not be disregarded due to lack of changes in vital signs.

Potential Adverse Effects of Spinal Immobilization in Children

Objective. The purpose of our study was to describe potential adverse effects associated with spinal immobilization following trauma among children. Methods. We conducted a prospective cohort study of children presenting to the emergency department (ED) for evaluation following trauma over a 13-month period. Children were eligible if they underwent spinal immobilization prior to physician evaluation or if they met the American College of Surgeons (ACS) guidelines for spinal immobilization but were not immobilized. We compared children who were immobilized with those who were not immobilized for self-reported pain, use of radiography to evaluate the cervical spine, ED length of stay, and ED disposition. We also report the characteristics of the cohort. Results. One hundred seventy-three spine-immobilized children and 112 children who met ACS criteria but were not immobilized were enrolled. There were differences between the two study groups, which included age, mechanism of injury, and proportion transported by emergency medical services. However, the comparison groups had comparable Pediatric Trauma Scores (PTSs) and Glasgow Coma Scale scores (GCSs). Immobilized children had a higher median pain score (3 versus 2) and were more likely to undergo cervical radiography (56.6% versus 13.4%) and be admitted to the hospital (41.6% versus 14.3%). The comparison groups had similar lengths of stay in the ED. Conclusion. Despite presenting with comparable PTSs and GCSs, children who underwent spinal immobilization following trauma had a higher degree of self-reported pain, and were much more likely to undergo radiographic cervical spine clearance and be admitted to the hospital than those who were not immobilized. Future studies are warranted to determine whether these differences are related to spinal immobilization or differences in the mechanisms of injury, injury patterns, or other variables.

The effect of spinal immobilization on healthy volunteers

To determine the effects of standard spinal immobilization on a group of healthy volunteers with respect to induced pain and discomfort. Prospective study. University teaching hospital. Twenty-one healthy volunteers with no history of back disease. Subjects were placed in standard backboard immobilization for a 30-minute period. Number and severity of immediate and delayed symptoms were determined. One hundred percent of subjects developed pain within the immediate observation period. Occipital headache and sacral, lumbar, and mandibular pain were the most frequent symptoms. Fifty-five percent of subjects graded their symptoms as moderate to severe. Twenty-nine percent of subjects developed additional symptoms over the next 48 hours. Standard spinal immobilization may be a cause of pain in an otherwise healthy subject.