In today’s micro-lecture, Australian Paramedical College Hon. Snr. Lecturer Sam Willis talks about how to manage the Cervical Collars.
In today’s micro-lecture, we’re going to talk about C spine immobilisation. Now, when you need to immobilise your patient’s C spine due to trauma, there’s a number of things that you need to take into consideration. Take a look at this image here. This image clearly shows you the cervical spine. It clearly shows that the top vertebrae are called cervical spine. Now there are generally seven cervical spines, with the two being called also the atlas and axis. When you start moving down this row of vertebrae, C3, 4, 5, are particularly important, because what you can see here is the spinal cord that runs through the vertebrae. The spinal cord that runs through the vertebrae at this level of C3, 4, 5, houses something called the phrenic nerve. It’s the phrenic nerve that’s responsible for respiration.
So it’s really important that when you have decided as a paramedic that the patient has a potential C spine injury, that you take into consideration the importance of this motion and movements that you’re going to put your patient and the paramedics through. Over the years, the choice whether to immobilise or to not immobilise, or the best devices to use to immobilise the C spine, has come under quite a considerable amount of debate. There’s still ongoing evidence that is trying to identify the best type of collar, if any at all. Now just be mindful there is a growing body of evidence that says that we shouldn’t even be putting any collars on our patient’s necks, because the patients are well placed to keep their heads nice and still. In fact all of the collars that we use today have been shown to cause some kind of tissue damage or raised intracranial pressure, depending on the type of collar used.
Let’s take a look at two of the most commonly type of collar, so the rigid collar and the soft collar. These are still used in practice today. Let’s focus in on this one here. These are still used today in practice. This is a semi-rigid collar. Notice how you’ve got the hard plastic part of the collar here, and then you’ve got the spongy foam. The spongy foam is designed to go round the neck and to be nice and soft on the patient to sit comfortably. Notice also how you’ve got these different sizes, depending on the length of neck. The idea is that you measure these collars up with your patient, place it directly around the patient’s neck, and then secure them at the back.
Let’s take a look at another type of stiff-neck collar. Excuse me, that’s not the right page. Stiff neck collar, that’s that one. The other one I want to show you is this one here. These ones are also commonly used in paramedic practice. They are adjustable, so you don’t have to set the collar that is one size fits all, like the No-Neck and like the ones we just showed you, but instead you have this type of device where you pull this plug out … and then you move this up or down depending on the size of the patient’s neck.
I also want to show you the soft collar as well, just very quickly. Soft collar immobilisation. Want to show you that one. The reason I want to show you this one is because this one is starting to be used more commonly now, particularly in some ambulance services rather than others. So this is the soft collar. The idea is that these are not rigid, they’re not hard. They go around the patient’s neck in exactly the same way as the hard collar. The difference being is that it’s supposed to be soft and cause less tissue pressure, cause less raised intracranial pressure by pressing on the neck here where all the important circulation is. However, as I’ve said, this is very much a choice made by the ambulance services. The idea is that whichever device you use, you’re supposed to be keeping that C spine nice and straight in neutral alignment.
Now you will be getting a chance to practice this in the workshops, but this is a nice introduction to the different types of collars. Please just understand that there is a lot of research being done in this space.