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miércoles, 10 de febrero de 2016

Myths about Long Backboards

emDocs - February 10, 2016 - Author: Joseph J and Bucher J 
Edited by: Robertson J and Koyfman A
Top 10 Myths About Cervical Spine Injury Management
  • Myth #1: Backboards can “neutralize” the cervical spine when used properly
  • Myth #2: The trauma surgeons will not support removing backboards from our treatment algorithm
  • Myth #3: Use of the LBB is a benign intervention that can only help my patient.
  • Myth #4: We should be attempting spinal motion restrictions on all trauma patients
  • Myth #5: We extricated the patient with a backboard and therefore, we need to leave the backboard in place until we get to the hospital.
  • Myth #6: Well, if I am not using the LBB on trauma patients anymore, then I still need to utilize a cervical collar… right?
  • Myth #7: People have come to expect the “board and collar” after an MVC and if I do not use them, then I will be sued.
  • Myth #8: Vacuum/inflatable/gel-padded backboards provide better spinal immobilization with increased comfort for our patients.
  • Myth #9: A provider should always be present to “clear” an ED patient off a backboard.
  • Myth #10: I need to keep long backboards on my ambulances for extrication of patients.
Top 5 Backboard Clinical Pearls
  1. The LBB should not be used as a therapeutic intervention. Achieving full spinal immobilization is not possible and its use has been shown to cause patient harm and no benefit. Instead, spinal motion restriction should be practiced.
  2. LBB use has been shown to cause increased pressure ulcers, decreased respiratory function, increased back pain, and result in a false-positive midline vertebral tenderness. This can result in unnecessary testing, radiation exposure and medical costs.
  3. Penetrating trauma alone does not increase the risk of cervical spine injury and these patients should never be immobilized.
  4. Attempting spinal motion restriction should not delay life-saving interventions or delay transport to definitive care.
  5. Consider RN-directed removal of backboards in the emergency department to avoid complications of prolonged, unnecessary immobilization.