The Mindset of a Trauma Surgeon: Karim Brohi
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This document discusses cervical collars and spinal immobilization. It makes the following key points: 1) Not all patients need immobilization, and self-extrication is possible in some cases. However, spine and spinal cord injuries should not be taken lightly. 2) There is little quality evidence on the harms or benefits of cervical collars. Prolonged immobilization is a bigger issue than collars alone. 3) Cervical collars should only be used for high-risk, unconscious or unsupervised patients. Most patients can be assessed and cleared within 2 hours. Collars should be replaced by alternative devices if clearance takes longer. 4) Proper immobilization protocols
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The Mindset of a Trauma Surgeon: Karim Brohi
- 1. COLLARSCOLLARS KARIM BROHI,KARIM BROHI, FRCS FRCAFRCS FRCA Professor of Trauma Sciences, Queen Mary University of LondonProfessor of Trauma Sciences, Queen Mary University of London Consultant Trauma & Vascular Surgeon, The Royal London Hospital / Barts HealthConsultant Trauma & Vascular Surgeon, The Royal London Hospital / Barts Health Clinical Lead, London’s Air AmbulanceClinical Lead, London’s Air Ambulance Director, London Major Trauma SystemDirector, London Major Trauma System Queen Mary University of London www.c4ts.qmul.ac.uk Royal London Major Trauma Centre Barts Health NHS Trust
- 2. LET’S AGREE…
- 3. LET’S AGREE… Not everyone needs immobilisation
- 4. LET’S AGREE… Self extrication is a thing
- 5. LET’S AGREE… Self-splinting is a thing
- 6. LET’S ALSO AGREE… Spine and spinal cord injuries are not a joke
- 7. LET’S ALSO AGREE…LET’S ALSO AGREE…
- 8. LET’S ALSO AGREE… Spine and spinal cord injuries are not a joke
- 9. LET’S ALSO AGREE… If this happens in your system you have a much bigger problem
- 10. LET’S NOT PRETEND… That there is any quality evidence
- 11. LET’S NOT PRETEND… That there is any quality evidence
- 12. It is easier to suggest harm than to prove harm It is MUCH EASIER to suggest harm than to prove benefit
- 13. It is easier to suggest harm than to prove harm It is MUCH EASIER to suggest harm than to prove benefit
- 14. Airway devices can… Increase aspiration Raise ICP Cause pressure ulcers Be uncomfortable
- 15. Airway devices can… Increase aspiration Raise ICP Cause pressure ulcers Be uncomfortable
- 16. Cervical collars can… Increase aspiration Raise ICP Cause pressure ulcers Be uncomfortable
- 17. LET’S ALSO NOT PRETEND… We know what a world without collars looks like
- 18. 28% 18% 25% 12%
- 19. LIFETIME COST OF TETRAPLEGIA: $4,000,000 CERVICAL COLLAR $10
- 20. LIFETIME COST OF TETRAPLEGIA: $4,000,000 CERVICAL COLLAR $10
- 23. LET’S ALSO NOT PRETEND… We have ever asked patients
- 25. COLLARS ARE A SIDESHOW
- 26. PROLONGED IMMOBILISATION IS THE ABSOLUTE ISSUE
- 28. IF YOU THINK COLLARS ARE THE PROBLEM YOUR SYSTEM IS BROKEN
- 29. IMMOBILISE HIGH-RISK ONLY UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION (UNLESS TRANSFERRING) CONSCIOUS AND/OR UNSUPERVISED PATIENT GETS A HARD COLLAR 99%+ OF PATIENTS SHOULD BE ASSESSED AND CLEARED WITHIN 2 HOURS IF CAN’T CLEAR IN THIS TIMEFRAME: REPLACE WITH MIAMI-J / PHILADELPHIA
- 30. IMMOBILISE HIGH-RISK ONLY UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION (UNLESS TRANSFERRING) CONSCIOUS AND/OR UNSUPERVISED PATIENT GETS A HARD COLLAR 99%+ OF PATIENTS SHOULD BE ASSESSED AND CLEARED WITHIN 2 HOURS IF CAN’T CLEAR IN THIS TIMEFRAME: REPLACE WITH MIAMI-J / PHILADELPHIA
- 31. IMMOBILISE HIGH-RISK ONLY UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION (UNLESS TRANSFERRING) CONSCIOUS AND/OR UNSUPERVISED PATIENT GETS A HARD COLLAR 99%+ OF PATIENTS SHOULD BE ASSESSED AND CLEARED WITHIN 2 HOURS IF CAN’T CLEAR IN THIS TIMEFRAME: REPLACE WITH MIAMI-J / PHILADELPHIA
- 32. IMMOBILISE HIGH-RISK ONLY UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION (UNLESS TRANSFERRING) CONSCIOUS AND/OR UNSUPERVISED PATIENT GETS A HARD COLLAR 99%+ OF PATIENTS SHOULD BE ASSESSED AND CLEARED WITHIN 2 HOURS IF CAN’T CLEAR IN THIS TIMEFRAME: REPLACE WITH MIAMI-J / PHILADELPHIA
- 33. IMMOBILISE HIGH-RISK ONLY UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION (UNLESS TRANSFERRING) CONSCIOUS AND/OR UNSUPERVISED PATIENT GETS A HARD COLLAR 99%+ OF PATIENTS SHOULD BE ASSESSED AND CLEARED WITHIN 2 HOURS IF CAN’T CLEAR IN THIS TIMEFRAME: REPLACE WITH MIAMI-J / PHILADELPHIA
- 35. IF YOU STILL THINK COLLARS ARE A PROBLEM DO THE RCT
- 36. 28% 18% 25% 12%
- 37. WHAT DO WE REALLY NEED TO CHANGE?