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03/03/2015

Stabilisation du rachis: C'est particulier en milieu hostile

Wilderness medical society: Practice Guidelines for spine immobilization in the austere environment.
Quinn R. et Al. Wilderness Environ Med. 2013 Sep;24(3):241-52

Recommandation 1 (grade:1C) :

Neutral alignment should be restored and maintained with light or moderate manual cervical traction during extrication, unless such a maneuver is met with resistance, increased pain, or new or worsening neurologic deficit.

Recommandation 2 (grade:1C):

Patients requiring extrication, when the cervical spine cannot be cleared before extrication, should be placed in a cervical collar and allowed to exit the situation under their own volition if alert and reliable. Otherwise extrication should be performed with a KED (or similar device) plusc ervical collar,and the immobilized patient moved in a sitting position onto a long spine board, vacuum mattress, orsimilar device.

Recommandation 3 (grade:1C):

The lift and slide transfer with trap squeeze is preferred to the log roll when transferring patients to and from a backboard

Recommandation 4 (grade:2C):

Spinal immobilization should be considered in patients with evidence of spinal injury, including those with neurologic injury, and those patients who have experienced severe trauma and are unconscious or exhibit altered mental status.

Recommandation 5 (grade:2B):

The cervical collar (or improvised equivalent) should beconsidered one ofs everal tools available to aid in immobilization of the cervical spine. It should not be considered adequate immobilization in and of itself, nor should it beconsidered necessary if adequate immobilization can be accomplished by other means, or if the presence of the collar in itself compromises emergent patient care.

Recommandation 6 (grade:1B):

Use of the cervical collar is contraindicated in ankylosing spondylitis. Patients with suspected injury should hav etheir neck supported in a position of comfort 

Recommandation 6 (grade:1C):

Vacuum mattress provides superior immobilization, with or without a standard cervical collar, and improved patient comfort (with corresponding decreased risk of pressure sores) and is preferred over a backboard for immobilization of either the entire spine or specific segments of concern.

 Recommandation 6 (grade:1A):

 Appropriately trained personnel, using either the NEXUS criteria or the Canadian C- spine rule, can safely and effectively make decisions in the prehospital setting about whether or not ac ervical spine should be immobilized.

Recommandation 7(grade:1B):

Spinal immobilization should not be performed in the presence of penetrating trauma

 

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