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How to Properly C-Spine a Patient with a Suspected Neck Fracture

By Edited Sep 6, 2016 1 0

There are numerous reasons why somebody would be placed in full c-spine immobilization. First off and the most obvious one would be a car or motorcycle accident.  Accidents like these tend to be the main reason for placing a person in c-spine. Some of the not so widely thought about reasons are an elderly patient that trips and falls or the bicyclist that falls while riding. There are numerous reasons to C-spine somebody. Just remember that is somebody has a traumatic injury on their body that the chance for a cervical injury is prominent. If a person is not completely alert or under the influence of alcohol or drugs, they can have masking injuries’s and not know if they are seriously injured. When in doubt, place them in c-spine.    

  The first thing to do when you come up on the scene of an accident is to make sure you are in a safe place. If you are in a hazardous condition you need to move to a safe environment. Once you are in a good location you have another rescuer place the patient in manual spinal immobilization. This is done by kneeling or sitting at patients head and putting their nose in a straight line with their belly button. The patients head should be in the “sniffing position”.  This should be done immediately and as smoothly as possible as the entire reason we are doing this is a suspected neck fracture.  Once the rescuer that places the patient in manual c-spine, they do not leave the head. That rescuer is in charge of all the movements to the patient. This is a critical role in making sure the patient is not injured any further. All movements will be made on a 3 count by the rescuer at the head.   

  The next procedure will be to place a cervical collar on the patient. This can be difficult due to different reasons. The patient might have a pony tail or necklaces on. Also large winter coats and hooded sweatshirts can be a c-spine nuisance. Coats and sweatshirts  need to be cut off most of the time. If necklaces are on they need to be removed. Ponytails have to be moved out of the way without moving the patients head.  Just remember that you need to move quickly but these procedures have to be executed properly as this patients future mobility is in our hands. The collar must be the proper size for the patient. To size the collar you place your fingers against the patient’s neck at the shoulder and measure how many fingers it takes to reach their jaw line. Then you measure your collar the same way, from the part of the collar that will be closest the shoulder and measure to the jaw line. Once the collar is properly sized, place the collar on the patient by sliding the back of the collar under the back of the patient’s neck and pulling the front around last. Then secure the collar with the provided Velcro. The collar should be snug but not so tight that the patient will have a hard time breathing. This all has to be done without moving the patient.   

 After the collar is in place the next step is to log roll and place the patient on a backboard. This can also be difficult for a number of reasons. Patient size and location is a major factor. If the patient is on the larger side, this can take numerous rescuers to get the job done. The rescuers need to place themselves at the side of the patient. Rescuer one has their hands on the shoulder and the hip of the patient. Rescuer two has their hands just above the knee and the other crossed over rescuer one’s hand just above the hip to form an X with the two inside arms of the rescuer’s.  Do not forget that the person on the head counts and states when to move the patient.  When everybody is ready the head rescuer counts to three and the patient is rolled on to their side. The head rescuer also moves in the head in conjunction with the other rescuers.  The patients should be in the same position just on their side. While the patient is on their side the back and spine need to be palpated and checked for any deformities. This will be difficult or impossible to perform while the patient is in c-spin so it is very important to check well and note any findings. After the back is checked a forth rescuer will slide a backboard under the patients hip. On the head rescuers count of three the patient is then rolled back on to the back board. Most of the time the patient is not positioned correctly on the backboard after log rolling them back. The head rescuer will then make a three count and the patient will be slid into place.   

  After the patient is in correct position on the backboard spider straps can be put in place. These straps hold the patient on the backboard. The shoulder straps are placed first with the feet straps second. The main connector strap needs to be in a straight line down the center of the patient. The middle holding straps can then be placed with one over the chest, one at the hips and one just above the knees. After all straps are in place they can be tightened into place. This is done with one rescuer on each side of the patient and at the same time.  Make sure that the straps are tight but the patient can still breathe.   

  The head blocks are then placed. This is when the head rescuer can move his hands. One rescuer places the block while the head rescuer moves his hand to then hold the block in place. The other side is done the exact same way. The head is then taped down to the back board.    This is just a quick rundown of how to place a trauma patient in c-spine. There are different steps that have to be taken for numerous situations as no patient is exactly the same. Just remember to use your best judgment, do not panic as you are there to inn that particular patients time of need.

Thanks and be safe,

Trauma Junkie

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