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Long spine board

From Wikipedia, the free encyclopedia Jump to: navigation, search For a backboard in basketball, see Basketball.

Spine immobilization with a long spine board A spinal board,[1] also known as a long spine board (LSB),[2] longboard,[3] spineboard,[4] or backboard,[5] is a patient handling device used primarily in pre-hospital trauma care designed to provide rigid support during movement of a patient with suspected spinal or limb injuries.[3] They are most commonly used by ambulance services, by staff such as emergency medical technicians and paramedics, but are also used by specialist emergency personnel such as lifeguards.[4]


1 Indications for use 2 Construction 3 Clinical issues 4 Alternatives 5 See also 6 References

Indications for use

A spinal board is primarily indicated for use in cases of trauma where the medical or rescue personnel believe that there is a possibility of spinal injury, usually due to mechanism of injury, and the attending team are not able to rule out a spinal injury. Due to the problems associated with extended use, it is designed primarily as an extrication device, especially from vehicles.[3] Backboards are almost always used in conjunction with the following devices:

a cervical collar with occipital padding as needed; side head supports, such as a rolled blanket or head blocks made specifically for this purpose, used to avoid the lateral rotation of the head; straps to secure the patient to the long spine board, and tape to secure the head

Spine boards are typically made of wood or plastic, although there has been a strong shift away from wood boards due to their higher level of maintenance required to keep them in operable condition and to protect them from cracks and other imperfections that could harbour bacteria. Backboards are designed to be slightly wider and longer than the average human body to accommodate the immobilization straps, and have handles for carrying the patient. Most backboards are designed to be completely X-ray translucent so that they do not interfere with the exam while patients are strapped to them. They are light enough to be easily carried by one person, and are usually buoyant.

Clinical issues
Common clinical issues found with spinal boards include pressure sore development, inadequacy of spinal immobilisation, pain and discomfort, respiratory compromise and affects on the quality of radiological imaging.[1] For this reason, some professionals view them as unsuitable for the task, preferring alternatives.[6] It is advised that no patient should spend more than 30 minutes on a spine board, due to the development of discomfort and pressure sores.[3]

The primary alternative, now considered gold standard for trauma care, is the vacuum mattress, which is flexible when soft, but it hardened through evacuation of air. The conforming nature of the vacuum mattress means that patients can be kept immobilised on it for longer periods of time and the immobilisation offers superior stability and comfort to the patient.[7] There are also short spine boards, but the short spine board is rarely used now due to the presence of superior devices, such as the Kendrick Extrication Device.

See also

Spinal injury Cervical collar Clearing the cervical spine


Cervical collar
From Wikipedia, the free encyclopedia Jump to: navigation, search

A side view of a person wearing a C spine collar.

A cervical collar (also neck brace) is an orthopedic piece of medical equipment used to support the cervical portion of a patient's spinal cord, and their head. It is also used by emergency medical services personnel for victims of traumatic head or neck injuries, [1] and can be used to treat chronic medical conditions. Whenever patients have a traumatic head or neck injury, there is a danger of spinal cord injury, which could lead to paralysis or death. In order to prevent this, patients may have a collar placed by medical professionals.[2] The cervical collar only stabilizes the top 7 vertebrae, C1 through C7. Other immobilizing devices such as a Kendrick Extrication Device, or a backboard must be used in order to stabilize the remainder of the spinal column.[3] Additional testing such as X-rays will later determine if a cervical spine fracture exists. A common scenario for this injury would be a patient suspected of having whiplash due to a car accident.[4] A cervical collar can also be therapeutic. It can help realign one's spinal cord and relieve pain,[5] though it is usually not worn for long periods of time.[6] Another use of the cervical collar is for strains, sprains or whiplash.[4][2] If pain is persistent, the collar might be required to remain attached to help in the healing process.[2][5] A patient might also need a cervical collar, or may require a halo to support their neck during recovery after surgeries such as cervical spinal fusion.

[edit] Cervical collar in sport

In high-risk motorsports such as Motorcross, go-kart racing and speed-boat racing racer will often wear a protective collar to avoid whiplash and other neck injuries by preventing excessive movement of the head. Designs range from simple foam collars to complex compsite devices.[8]

A Motorcross rider wearing a sports neck brace

A fourteen month old infant wearing a neckbrace after sustaining a skull fracture, at the Children's Hospital of Orange County on September 23, 2007.

Lateral view of a cervical collar

AP view of a cervical collar

[edit] See also

Neck corset Long spine board

[edit] References
1. ^ Mistovich, Joseph J.; Brent Q. Hafen, Keith J Karren (2000) (in English). Brady Prehospital Emergency Care (6 ed.). Upper Saddle River, NJ: PrenticeHall. pp. 662. ISBN 0-8359-6064-1. 2. ^ a b c "Neck Strains". WebMD. Retrieved 2008-03-07.

3. ^ Mistovich, Joseph J.; Brent Q. Hafen, Keith J Karren (2000) (in English). Brady Prehospital Emergency Care (6 ed.). Upper Saddle River, NJ: PrenticeHall. pp. 662. ISBN 0-8359-6064-1. 4. ^ a b "Whiplash". WebMD. Retrieved 2008-03-07. 5. ^ a b "Cervical Disc Disease Treatment: Physical Therapy and Other Options". WebMD. Retrieved 2008-03-07. 6. ^ "Office Ergonomics - Other Treatment for Injuries Related to the Workstation". WebMD. Retrieved 2008-03-07. 7. ^ "Cervical spinal fusion". WebMD. Retrieved 2008-03-07. 8. ^ "Valhalla Adult 360 Plus Devise Karting Neck Brace". Retrieved 2010-08-16. Retrieved from "" Categories: Emergency medical equipment | Orthopedic braces | Protective gear Personal tools Log in / create account

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Adjuncts to airway management

There are a variety of artificial airways which can be used to keep a pathway between the lungs and mouth/nose. The most commonly used in long term or critical care situations is the endotracheal tube, a plastic tube which is inserted through the mouth and into the trachea, often with a cuff which is inflated to seal off the trachea and prevent any vomit being aspirated into the lungs. In some cases. a laryngeal mask airway (LMA) is a suitable alternative to an endotracheal tube, and has the advantage of requiring a lower level of training that an ET tube. In the case of a choking patient, laryngoscopy or even bronchoscopy may be performed in order to visualise and remove the blockage.

An oropharyngeal airway or nasopharyngeal airway can be used to prevent the tongue from blocking the airway. When these airways are inserted properly, the rescuer does not need to manually open the airway with a head tilt/chin lift or jaw-thrust maneuver. Aspiration of blood, vomitus, and other fluids can still occur with these two adjuncts. Oropharyngeal airway The oropharyngeal airway is essentially a curved hollow tube that is used to create an open conduit through the mouth and posterior pharynx. A rough guide for choosing the correct size is to hold the airway beside the patient's mandible, orienting it with the flange at the patient's mouth and the tip at the angle of jaw. The tip should just reach the angle of the jaw. While inserting the airway you want to avoid pushing the tongue into the posterior pharynx. This can be accomplished by starting with the curve of the airway inverted, and then rotate the airway as the tip reaches the posterior pharynx. Alternatively a tongue depressor can be used to move the tongue out of the way as the airway is passed. Whichever technique is chosen the physician must be certain that the airway is indeed in the right position. If there are problems ventilating the patient after insertion of the airway then it should be removed and reinserted. Nasopharyngeal airway

The nasopharyngeal airway is a soft rubber or plastic hollow tube that is passed through the nose into the posterior pharynx. The tubes come in sizes based on the internal diameter(i.d.) of the tube. The larger the internal diameter the longer the tube. An 8.0 9.0 i.d. is used for a large adult, a 7.0 8.0 i.d. for a medium adult and a 6.0 7.0 i.d. for a small adult. These tubes can be used when the use of an oropharyngeal airway is difficult, such as when a patient is clenching their jaw. As well, the nasopharyngeal airway is generally better tolerated than the oropharyngeal airway in a semiconscious patient. To insert, the nasopharyngeal airway is lubricated with water soluble lubricant or anesthetic jelly along the floor of the nostril into posterior pharynx behind the tongue. quipment tray

Gloves The rescuer should at all times avoid direct contact with the blood and other body fluids of the patient. If available, gloves should be worn during all airway management procedures.

Suction In most resuscitation situations, the patient will either vomit, or at the very least, have an excess of secretion in their oropharynx. If available, a suction catheter should be included as part of your basic airway equipment.

Lubricant If a nasopharyngeal airway is used, it will require lubrication of its outer surface prior to insertion. Xylocaine(R) Jelly is used because it is a good lubricant and it reduces irritaion through its local anesthetic effect.

Nasopharyngeal Airway The nasopharyngeal airway is made of soft, pliable plastic, and is inserted through the nares and into the nasopharynx, thus providing a patent airway to facilitate chest ventilation. It has the advantage of being better tolerated in the conscious or semi-conscious patient than the oropharyngeal airway. It is also easier to insert in a patient who has his/her teeth clenched. It is important to note that the NP airway does not protect the airway from aspiration of vomitus.

Oropharyngeal Airway The oropharyngeal airway is a rigid plastic device, which is inserted through the mouth into the oropharynx. This provides a patent airway to facilitate chest ventilation. It is important to note that the OP airway does not protect the airway from aspiration of vomitus.

Bag-Valve Ventilator The bag-valve ventilator is a device designed to ventilate the chest. By attaching an oxygen supply, it can be used to ventilate the chest with a high concentration of oxygen. The bag-valve ventilator can be used with a mask, as in basic airway management, or it can be attached to an endotracheal tube as part of advanced airway management.

Mask Masks are used to provide a tight seal between the patient's face and the bag-valve ventilator. Masks come in various sizes. The correct size of the mask for a particular patient should provide a tight seal around the nose and mouth. The pointed end of the mask creates a seal over the bridge of the patient's nose, while the round end creates a seal between the lower lip and chin. ygen tank is a storage vessel for oxygen, which is either held under pressure in gas cylinders or as liquid oxygen in a cryogenic storage tank. Oxygen tanks are used to store gas for:

industrial processes including the manufacture of steel and monel oxyacetylene welding equipment and some gas cutting torches use as the liquid rocket propellants for rocket engines medical breathing gas at medical facilities and at home breathing at altitude in aviation, either in an uncontrolled decompression emergency, or constantly (in the case of unpressurized aircraft) oxygen first aid kits gas blending for creating diving breathing mixes such as nitrox, trimix and heliox open-circuit scuba sets - mainly used for accelerated decompression in technical diving some types of diving rebreather: oxygen rebreathers and fully closed circuit rebreathers

Breathing oxygen is delivered from the storage tank to the users by use of the following methods: oxygen mask, nasal cannula, full face diving mask, oxygen tent, and hyperbaric oxygen chamber. Contrary to popular belief scuba divers very rarely carry oxygen tanks. The vast majority of divers breathe air or nitrox stored in a diving cylinder. A small minority breathe trimix, heliox or other exotic gases. Some of these may carry pure oxygen for accelerated decompression or as a component of a rebreather. Some shallow divers, particularly naval divers, use oxygen rebreathers or have done so historically. As liquid oxygen at atmospheric pressure boils at -183C / -297F a liquid oxygen tank must store the oxygen below that temperature and be a good thermal insulator. Oxygen is rarely held at pressures higher than 200 bar / 3000 psi due to the risks of fire triggered by high temperatures caused by adiabatic heating when the gas changes pressure when moving from one vessel to another. All equipment coming into contact with high pressure oxygen must be "oxygen clean" and "oxygen compatible" to reduce the risk of fire.[1][2] "Oxygen clean" means the removal of any

substance that could act as a source of ignition. "Oxygen compatible" means that internal components must not burn readily or degrade easily in a high pressure oxygen environment. In some countries there are legal and insurance requirements and restrictions on the use, storage and transport of pure oxygen. Oxygen tanks are normally stored in well ventilated locations, far from potential sources of fire and concentrations of people.