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C-spine immobilisation

Simon Sulser, Dirk Ubmann, Martin Schlaepfer, Martin Brueesch, Georg Goliasch, Burkhardt Seifert, Donat R Spahn, Kurt Ruetzler
BACKGROUND: Airway management in the emergency room can be challenging when patients suffer from life-threatening conditions. Mental stress, ignorance of the patient's medical history, potential cervical injury or immobilisation and the presence of vomit and/or blood may also contribute to a difficult airway. Videolaryngoscopes have been introduced into clinical practice to visualise the airway and ultimately increase the success rate of airway management. OBJECTIVE: The aim of this study was to test the hypothesis that the C-MAC videolaryngoscope improves first-attempt intubation success rate compared with direct laryngoscopy in patients undergoing emergency rapid sequence intubation in the emergency room setting...
August 16, 2016: European Journal of Anaesthesiology
A Germaneau, T Vendeuvre, M Saget, P Doumalin, J C Dupré, F Brémand, F Hesser, M Couvertier, C Brèque, P Maxy, M Roulaud, O Monlezun, P Rigoard
Kyphoplasty has been shown as a well-established technique for spinal injuries. This technique allows a vertebral bone augmentation with a reduction of morbidity and does not involve any adjacent segment immobilisation. There is a lack of biomechanical information resulting in major gaps of knowledge such as: the evaluation of the "quality" of stabilisation provided by kyphoplasty as a standalone procedure in case of unstable fracture. Our objective is to analyse biomechanical response of spine segments stabilised by Kyphoplasty and PMMA cement after experiencing burst fractures...
June 2016: Journal of the Mechanical Behavior of Biomedical Materials
K Pringle, J M Mackey, P Modi, H Janeway, T Romero, F Meynard, H Perez, R Herrera, M Bendana, A Labora, J Ruskis, J Foggle, R Partridge, A C Levine
INTRODUCTION: Morbidity and mortality from intentional and unintentional injury accounts for a high burden of disease in low- and middle-income countries. In addition to prevention measures, interventions that increase healthcare capacity to manage injuries may be an effective way to decrease morbidity and mortality. A trauma curriculum tailored to low-resource settings was implemented in Managua, Nicaragua utilising traditional didactic methods and novel low-cost simulation methods. Knowledge gain in attending and senior residents was subsequently assessed by using pre- and post-written tests, and by scoring pre- and post-simulation scenarios...
September 2015: Injury
Marike C Kokke, Wietske Ham, Loek P H Leenen
The latest version of the Dutch National Protocol Ambulance Care (Landelijk Protocol Ambulancezorg LPA8), introduced on 1 January 2015, contains too few guarantees of the safety of trauma patients in whom spinal immobilisation has to be performed. A number of strict indications have been removed and too much freedom is also permitted with respect to implementation. Although the previous standard method using a spinal board, collar and blocks did have disadvantages, the new operating method has been insufficiently substantiated and, in addition, is not well matched to the protocols of Accident and Emergency departments...
2015: Nederlands Tijdschrift Voor Geneeskunde
S Brück, H Trautner, A Wolff, J Hain, G Mols, P Pakos, N Roewer, M Lange
In-line stabilisation of the neck can increase the difficulty of tracheal intubation with direct laryngoscopy. We randomly assigned 56 patients with cervical spine pathology scheduled for elective surgery to tracheal intubation using either the C-MAC(®) (n = 26) or GlideScope(®) (n = 30), when the head and neck were stabilised in-line. There was no significant difference in the median (IQR [range]) intubation times between the C-MAC (19 (14-35 [9-90]) s and the GlideScope (23, (15-32 [8-65]) s. The first-attempt failure rate for the C-MAC was 42% (95% CI 23-63%) compared with 7% (95% CI 1-22%) for the GlideScope, p = 0...
February 2015: Anaesthesia
Padmaja Durga, Chiranjeevi Yendrapati, Geeta Kaniti, Narmada Padhy, Kiran Kumar Anne, Gopinath Ramachandran
BACKGROUND AND AIMS: Cervical spine immobilisation with rigid cervical collar imposes difficulty in intubation. Removal of the anterior part of the collar may jeopardize the safety of the cervical spine. The effect of restricted mouth opening and cervical spine immobilisation that result from the application of rigid cervical collar on intubation using Airtraq(®) was evaluated. METHODS: Seventy healthy adults with normal airways included in the study were intubated Using Airtraq® with (group C) and without rigid cervical collar (group NC)...
July 2014: Indian Journal of Anaesthesia
S Ilyas, J Symons, W P L Bradley, R Segal, H Taylor, K Lee, M Balkin, C Bain, I Ng
Cervical spine immobilisation can make direct laryngoscopy difficult, which might lead to airway complications. This randomised control trial compared the time to successful intubation using either the Macintosh laryngoscope or the McGrath(®) Series 5 videolaryngoscope in 128 patients who had cervical immobilisation applied. Intubation difficulty score, Cormack & Lehane laryngoscopic view, intubation failures, changes in cardiovascular variables and the incidence of any complications were recorded. The mean (SD) successful intubation time with the Macintosh laryngoscope was significantly shorter compared with the McGrath laryngoscope, 50...
December 2014: Anaesthesia
Mathias C Blom, Ludwig Aspelin, Kjell Ivarsson
BACKGROUND: In 2005, the Advanced Life Support (ALS) teams delivering pre-hospital care in RegionSkane in southern Sweden received additional support by physicians, who were part of "Pre-hospital acute teams" (PHAT). The study objective is to compare the incidence of pre-hospital medical interventions for trauma-patients cared for by conventional ALS teams and patients who received additional support by PHAT. METHODS: Trauma patients with Injury Severity Score (ISS) >9 were identified retrospectively in the national quality registry KVITTRA at three hospitals in RegionSkane, for the time period October 2005 to December 2008...
2014: Journal of Trauma Management & Outcomes
C W J Oomens, W Zenhorst, M Broek, B Hemmes, M Poeze, P R G Brink, D L Bader
BACKGROUND: Spine boards are used to immobilise accident victims suspected of having spinal injury. Guidelines about the maximum time patients remain on the board are often exceeded and on occasions may lead to pressure ulcers. Etiological research has shown that two processes ultimately lead to pressure ulcers:"Ischemic damage" which takes several hours to initiate and "deformation damage" at high strains. The latter process is very quick and the first signs of cell damage are already evident within minutes...
August 2013: Clinical Biomechanics
James O M Plumb, C G Morris
PURPOSE: Controversy exists over how to 'clear' (we mean enable the clinician to safely remove spinal precautions based on imaging and/or clinical examination) the spine of significant unstable injury among clinically unevaluable obtunded blunt trauma patients (OBTPs). This review provides a clinically relevant update of the available evidence since our last review and practice recommendations in 2004. METHODS: Medline, Embase. Google Scholar, BestBETs, the trip database, BMJ clinical evidence and the Cochrane library were searched...
May 2012: Intensive Care Medicine
Antoine Gerometta, Fabian Bittan, Juan Carlos Rodriguez Olaverri
INTRODUCTION: Postoperative spondylodiscitis is a primary infection of the nucleus pulposus with secondary involvement of the cartilaginous endplate and vertebral bone. Although uncommon, postoperative spondylodiscitis causes major morbidity and may be associated with serious long-term sequelae. Several risk factors had been identified, including immunosuppression, obesity, alcohol, smoking, diabetes and malnutrition. MATERIALS AND METHODS: A review of the literature was done to analyse the diagnosis, treatment and prevention of postoperative spondylodiscitis...
February 2012: International Orthopaedics
A F Mavrogenis, G Guerra, M Romantini, C Romagnoli, R Casadei, P Ruggieri
PURPOSE: This paper presents a single institution's longterm experience regarding the incidence and management of tumours of the atlas and axis and discusses clinical and imaging findings and treatment options. MATERIALS AND METHODS: We searched the registry of the Istituto Ortopedico Rizzoli for patients admitted and treated for tumours of the upper cervical spine. We identified 62 patients over 37 years, from July 1973 to October 2010. There were 39 male and 23 female patients, with a mean age of 39...
June 2012: La Radiologia Medica
Patricia M de Moraes Barros Fucs, Robert Meves, Helder Henzo Yamada
Spondylodiscitis affects children aged between two and eight years, and mainly involves the lumbar or lumbosacral spine. Diagnosis is difficult because the symptoms are not very specific and due to the children's difficulty in communicating. Unlike adults, children have vascularised intervertebral discs, which explains the higher incidence of this disease in this age group. C-reactive protein, and blood and urine cultures are important laboratory tests. In most cases, fine needle or traditional biopsy helps identify the pathogen particularly in patients who do not respond to the antibiotic therapy test...
February 2012: International Orthopaedics
L Löhrer, M J Raschke, D Thiesen, R Hartensuer, C Surke, S Ochman, T Vordemvenne
Although currently there are many different recommendations and strategies in the therapy of odontoid fractures in the elderly, there are still no generally accepted guidelines for a structured and standardised treatment. Moreover, the current opinion of spine surgeons regarding the optimal treatment of odontoid fractures Type II of the elderly is unknown. In order to have an objective insight into the diverging strategies for the management of Anderson Type II odontoid fractures and form a basis for future comparisons, this study investigated the current concepts and preferences of orthopaedic, neuro- and trauma surgeons...
April 2012: Injury
M Stoffel, C Stüer, F Ringel, B Meyer
Spinal infection may involve the vertebrae, the intervertebral discs, and the adjacent intraspinal and paraspinal soft tissues. It often starts with subtle and insidious clinical signs and symptoms and may development to a debilitating and even life threatening disease. Spinal infections occur with increasing incidence and are nowadays a disease of everyday's practice for physicians treating spinal disorders. Traditionally, conservative treatment consisting of antibiosis and immobilisation is considered the first tier therapy...
2011: Advances and Technical Standards in Neurosurgery
Jan Breckwoldt, Sebastian Klemstein, Bergit Brunne, Luise Schnitzer, Hans-Christian Mochmann, Hans-Richard Arntz
OBJECTIVES: For experienced personnel endotracheal intubation (ETI) is the gold standard to secure the airway in prehospital emergency medicine. Nevertheless, substantial procedural difficulties have been reported with a significant potential to compromise patients' outcomes. Systematic evaluation of ETI in paramedic operated emergency medical systems (EMS) and in a mixed physician/anaesthetic nurse EMS showed divergent results. In our study we systematically assessed factors associated with difficult ETI in an EMS exclusively operating with physicians...
December 2011: Resuscitation
Bs Teh, C Bloch, M Galli-Guevara, L Doh, S Richardson, S Chiang, P Yeh, M Gonzalez, W Lunn, R Marco, J Jac, Ac Paulino, Hh Lu, Eb Butler, Rj Amato
PURPOSE: Brain metastases from renal cell carcinoma (RCC) have been successfully treated with stereotactic radiosurgery (SRS). Metastases to extra-cranial sites may be treated with similar success using stereotactic body radiation therapy (SBRT), where image-guidance allows for the delivery of precise high-dose radiation in a few fractions. This paper reports the authors' initial experience with image-guided SBRT in treating primary and metastatic RCC. MATERIALS AND METHODS: The image-guided Brainlab Novalis stereotactic system was used...
January 2007: Biomedical Imaging and Intervention Journal
J L Rakotoson, J R Rakotomizao, A C F Andrianarisoa
Pott's disease, or tuberculosis of the spine, is the most common osteoarticular tuberculosis. Among them, dorsolumbar impairment is predominant. The authors report the case of a patient with a huge cold lumbar abscess associated with Pott's disease. The patient is a 32-year-old man presenting dorsolumbar tumefaction associated with an alteration in his general condition and fever for three months. Treatment by "traditional healers" did not provide any improvement. He consulted for mild lumbar pain triggered by fatigue appearing one week before and after the failure of the traditional practitioner...
December 2010: Revue de Pneumologie Clinique
I Bathory, P Frascarolo, C Kern, P Schoettker
Application of cervical collars may reduce cervical spine movements but render tracheal intubation with a standard laryngoscope difficult if not impossible. We hypothesised that despite the presence of a Philadelphia Patriot cervical collar and with the patient's head taped to the trolley, tracheal intubation would be possible in 50 adult patients using the GlideScope and its dedicated stylet. Laryngoscopy was attempted using a Macintosh laryngoscope with a size 4 blade, and the modified Cormack-Lehane grade was scored...
December 2009: Anaesthesia
Emile J W Keuter, Jan M Minderhoud, Arianne P Verhagen, Mirjam Valk, C J G M Kitty Rosenbrand
A multidisciplinary guideline for the intake and treatment of whiplash patients has been developed with regard to the impact of whiplash on public health and social security. This guideline is restricted to uncomplicated whiplash, which is defined as the sudden acceleration and deceleration of the skull with energy transfer to the neck without neurological sequelae or fractures. In whiplash victims who are not alert, have pain of the neck, diminished cervical mobility or pain on palpation of the cervical vertebrae, an X ray of the cervical spine should be carried out to exclude fractures...
2009: Nederlands Tijdschrift Voor Geneeskunde
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