A talk from The Big Sick conference in Zermatt, 2018. All talks: https://scanfoam.org/tbs18/ and https://scancrit.com

1. Spinal stabilization
- state of the art?
Dr. Per Kristian Hyldmo, PhD
Head of Trauma, Sørlandet hospital, Norway
Associate professor, University of Stavanger, Norway

2. Conflicts of interest:
Instituted the Lateral Trauma
Position
- no economical benefits

5. National
process

7. To make a
guideline…

8. When there’s
little evidence…

9. Har
mBenefit

10. Frequency vs.
consequence

11. Consequenc
e
Probability

12. TBI

13. SCI

14. Consequenc
e
Probability

15. What do we
know?

16. NATO Emergency War Surgery
Handbook 1957

18. Benefit?

21. “Conclusively, we propose a safe,
effective strategy for prehospital
spinal immobilization that does not
include routine use of collars.”

23. Harm?

25. “Because airway obstruction is a major cause of
preventable death in trauma patients, and spinal
immobilisation, particularly of the cervical spine,
can contribute to airway compromise, the
possibility that immobilisation may increase
mortality and morbidity cannot be excluded.”

26. Is supine
dangerous?

27. favours lateral favours supine

28. Spinal

29. Lateral Trauma
Position

34. LTP ≈ logroll

35. Harm?

37. Harm?

38. From: trauma.org

39. Penetrating
trauma

40. Clinical
clearance

41. How?

42. Better

43. VM

45. How?

46. How?

48. ”When patients with
injuries were not placed
on motion restrictions,
there were no negative
clinical outcomes.”

50. Critical injury?

51. Trauma
patient
Critical injury?
10 > RF > 30
and/or
HR > 120
and/or
no radial pulse
Do not delay
transport
• Manual stabilisation
• Supine?
• Lateral trauma
position?
One or more:
• Tenderness,
columna
• GCS < 15
• Intoxicated
• Neurological deficit
• Distracting pain
Spinal
stabilisation
• Cervical collar
• Manual stabilisation
• Blanket roll?
• Ambulance gurney
• Vacuum mattress
No spinal
stabilisation
NO
NO to all
YE
S
YE
S

52. Trauma
patient
Critical injury?
10 > RF > 30
and/or
HR > 120
and/or
no radial pulse
Do not delay
transport
• Manual stabilisation
• Supine?
• Lateral trauma
position?
One or more:
• Tenderness,
columna
• GCS < 15
• Intoxicated
• Neurological deficit
• Distracting pain
Isolated
penetrating
trauma?
Spinal
stabilisation
• Cervical collar
• Manual stabilisation
• Blanket roll?
• Ambulance gurney
• Vacuum mattress
No spinal
stabilisation
NO
NO to all
YE
S
YE
S

53. Overcautious?

54. Invite to self-extract

55. Invite to self-
extract

56. Critical:
ABC & time

57. Supine is
dangerous

58. LTP

59. Clinical
clearance

60. Vacuum
mattress

61. Invite to
self-extract

62. Not this way

63. Thank you!
pkh@sshf.no