Findings such as continuous oozing, subcutaneous emphysema and especially expanding haematoma were initially missed.
Current literature does not directly address the indications, benefit and risk concerning so-called immobilization for penetrating neck injuries. This is true for both journals and major trauma textbooks. Most authors simply recommend that all patients with such injuries should be immobilized, or merely state that such is the practice in their emergency department and pre-hospital trauma care. Even the manual of the ATLS does not make a distinction between blunt and penetrating neck trauma, generally stating that "any patient with a suspected spine injury must be immobilized above and below the suspected injury site until injury has been excluded by roentgenograms". In addition it stresses that "cervical spine injury requires continuous immobilization of the entire patient with a semi-rigid cervical collar, backboard, tape and straps before and during transfer to a definite-care facility". (Sauerland, 2004) In depth analysis of the text following these statements reveals that the author is referring only to casualties from blunt injury!
Although there is no proven benefit of spin...
Immobilization has been demonstrated to cause back and head pain, resulting in an increased number of radiographs required to clear the spine in the emergency department (ED). Rigid spine immobilization can also cause pressure-related tissue breakdown, restrict respirations, and, if used aggressively, actually cause spinal cord injury. (Jones, 2004)
Importance of Spinal Immobilization
ED studies have confirmed the ability of clinical criteria to reliably determine the need for spine radiographs, although the majority of these have addressed only the cervical spine. Stevens reported that only a small number of patients with cervical spine injury escaped capture using clinical clearance criteria in the ED. Although the ED use of clinical spine clearance protocols has been reported, the validity of using a similar protocol in the EMS setting has not been fully addressed. The goal of prehospital management of SCI is to reduce neurological deficit and to prevent any additional loss of neurological function. (March, 2002) Therefore, prehospital management at the scene should include a rapid primary evaluation of the patient, resuscitation of vital functions (airway, breathing, circulation; the "ABCs"), a more detailed secondary assessment, and finally definitive care (including transport and admission to a trauma centre). Moreover, after arrival at the scene, it is important to "read" the scene and to appreciate the mechanism of injury in order to identify the potential for SCI. Prehospital management in general and the management of the airway and ventilation in particular should include immobilisation of the spine in suspicious cases to reduce the risk of a secondary SCI. (Hoffman, 2000) Cardiovascular