Page 200 - Ultrasonography in Prehospital and Emergency Medicine - Rein Ketelaars
P. 200

                 198
Chapter 9
immobilization. Practice in the Netherlands is based on the evidence that the application of a rigid cervical collar increases ICP in severely brain-injured patients and the use of the collar is of questionable benefit in patients immobilized on a spine board or a vacuum mat- tress.4–7, 23 Alternative strategies are used, such as manual in-line stabilization during extrica- tion and vacuum mattress, and head blocks fixed with Velcro straps to a spine board during transportation.1,2,4–6,23,24
Conclusions
Application of a rigid cervical collar significantly increases the ONSD in healthy volunteers with intact cerebral autoregulation. This suggests that ICP may increase after application of a collar. In healthy volunteers, the effect is limited and seems to be of minor importance. If baseline ICP is increased or autoregulation is impaired in a head-injured patient, this mech- anism might worsen CBF. On the basis of our findings the effect of the collar on ONSD and ICP in patients with mild and moderate TBI needs to be determined.
Acknowledgements
The authors thank Tom Fugers from Secma B.V., Vianen, the Netherlands, for his unrestrict- ed cooperation by providing two ultrasound machines and transducers for this study.
  



























































































   198   199   200   201   202