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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, April 3, 2014

Collarín cervical

Posted on April 2, 2014 by Thomas D
"And so the rigid cervical collar is laid to rest in the Emergency Medical Service (EMS) of Bergen, Norway. Bergen is the second largest city in Norway, and has an active HEMS department at Bergen University Hospital. Particularly, HEMS doc Helge Asbjørnsen has being a strong advocate against the cervical collar, providing the basis for our “Curse of the Cervical Collar” post. Now, the latest EMS SOP is – for all practical purposes – getting rid of the cervical collar in Bergen’s ambulance service.
C-collar killer
If DeBacker is the Dopamine killer, Asbjørnsen seems to be the c-collar killer. The SOP is based on the increasing sceptisism to immobilisation in general and against the rigid cervical collar in particular. Despite long standing use, there has not been any proven benefit from the use of cervical collars in trauma patients, but instead some increasing (although not very strong) evidence of possible harm and unwanted effects.
  1. The cervical collar can lead to increased movement in the upper parts of the neck compared to no collar.
  2. In patients with trauma affecting the spine, available evidence points to larger neurological deficits in areas where the cervical collar is routine vs areas where they are not in use.
  3. The cervical collar increases ICP because of decreased venous return due venous compression of the neck
  4. The cervical collar hampers airway management
  5. Cervical collars leads to increased risk of aspiration."