Per Kristian Hyldmo's talk at The Big Sick 2018 in Zermatt. Rest of talks: https://scanfoam.org/bigsick18/

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. Harm
Benefit

10. Frequency vs.
consequence

11. Consequence
Probability

12. TBI

13. SCI

14. Consequence
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 injury??

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 better

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
YES
YES

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
YES
YES

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