Cervical collar
From TraumaWiki.com
Contents |
Background
A cervical collar is an orthopedic piece of medical equipment used to support a patient's spinal cord and head. A cervical collar can help realign one's spinal cord or to maintain neutral alignment of the spine. It may also help relieve pain, although it should only be worn for as long as the doctor states, since collars are usually not worn for long periods of time. After cervical spinal fusion, which can include joining metal plates or removing spinal disc from the vertebrae, a patient might need a cervical collar to support their neck during recovery. An alternative name for cervical collar is a "neck brace".
Another use of the cervical collar is for strains or sprains. When a patient might have a neck injury and require examination, they will be carried off in an ambulance with a collar attached. If pain is persistent, the collar might be required to remain attached to help in the healing process. If a patient needs to have X-rays taken of their head or neck, then the collar will remain in place until healing is done, such as in the cases of whiplash due to a car accident.
Collars are sized for persons of all ages and size, and they vary in color. They also can be hard or soft, although even hard ones will be layered with foam to provide comfort during healing, while soft ones are to benefit one in pain. Hospital ambulances usually always carry an array of collars.
Types of Cervical Collars
All multi-trauma patients with suspected cervical spine injury should have their cervical spine protected while other life-threatening injuries are being managed. The application of a hard cervical collar is an acceptable method of temporarily immobilizing the cervical spine [3]. There are several types of cervical collars: (a) Standard foam cervical collar; (b) Philadelphia cervical collar; (c) Miami-J collar; (d) Thomas-type cervical collar; and (e) The Aspen collar [1].
Cervical Collars: Complications
Prolonged or inappropriate use of cervical collars may be associated with significant morbidity. The most commonly seen complication of cervical collars is the formation of pressure ulcers secondary to pressure points from the collar itself [2].
The most common adverse complication associated with cervical immobilization is skin breakdown. The purpose of this prospective, descriptive study was to assess the incidence of tissue breakdown associated with cervical immobilization. In this convenience sample of 484 patients, skin breakdown was noted in 33 (6.8%) patients. All cases of documented skin breakdown were stage I or II, with only 2 (0.4%) patients having stage III breakdown. Days in the cervical collar is a significant predictor of skin breakdown, along with presence of edema. Results from this study demonstrate that there is a very low incidence of complications of skin breakdown associated with the use of Aspen cervical collars. The collars are safe and effective to use in patients with actual or suspected head or spine injurieshow to get rid of stretch marks
Cervical Collars: Effect on Intracranial Pressure
Rigid collars are routinely used to immobilise the cervical spine during early management of trauma victims until spinal injury is excluded. Spinal injuries commonly coexist in patients with severe head injury, and there is still uncertainty as to whether application of a rigid collar may adversely affect intracranial pressure. The aim of this study was to examine this effect by applying rigid collars to patients with traumatic head injury. The results showed a significant rise from the baseline intracranial pressure when the collars were applied (mean rise = 4.6 mmHg, p < 0.0001). The mean rise in intracranial pressure was greater in those patients with a baseline intracranial pressure > 15 mmHg compared to those with a baseline intracranial pressure < 15 mmHg (p < 0.05). Since there was no significant change in cardiorespiratory parameters during this time, venous compression in the neck seems a likely explanation for the effect observed. These findings suggest that in head-injured patients, rigid collars should be removed as soon as cervical spine injury has been excluded or, if this is delayed, an alternative method of spinal stabilisation considered [4].
Notes & References
[1] Cervical Collar. Available online at: http://www.supports4u.com/Cervical.htm. Last accessed on March 26, 2008.
[2] Powers J, Daniels D, McGuire C, Hilbish C. The incidence of skin breakdown associated with use of cervical collars. J Trauma Nurs. 2006;13:198-200.
[3] Liew SC, Hill DA. Complication of hard cervical collars in multi-trauma patients. Aust N Z J Surg. 1994;64:139-40.
[4] Hunt K, Hallworth S, Smith M. The effects of rigid collar placement on intracranial and cerebral perfusion pressures. Anaesthesia. 2001;56:511-513.
Credits & Notices
Authors-contributors to this page (listed alphabetically, last name, first & middle initial only, no institutional affiliations, no scientific titles):
Stawicki SP
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