COLLARS COLLARS KARIM BROHI, KARIM BROHI, FRCS FRCA FRCS FRCA Professor of Trauma Sciences, Queen Mary University of London Professor of Trauma Sciences, Queen Mary University of London Consultant Trauma & Vascular Surgeon, The Royal London Hospital / Barts Consultant Trauma & Vascular Surgeon, The Royal London Hospital / Barts Health Health Clinical Lead, London’s Air Ambulance Clinical Lead, London’s Air Ambulance Director, London Major Trauma System Director, London Major Trauma System Queen Mary University of London www.c4ts.qmul.ac.uk Royal London Major Trauma Centre Barts Health NHS Trust
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
COLLARSCOLLARS
KARIM BROHI, KARIM BROHI, FRCS FRCAFRCS FRCA
Professor of Trauma Sciences, Queen Mary University of LondonProfessor of Trauma Sciences, Queen Mary University of LondonConsultant Trauma & Vascular Surgeon, The Royal London Hospital / Barts HealthConsultant Trauma & Vascular Surgeon, The Royal London Hospital / Barts HealthClinical Lead, London’s Air AmbulanceClinical Lead, London’s Air AmbulanceDirector, London Major Trauma SystemDirector, London Major Trauma System
Queen Mary University of Londonwww.c4ts.qmul.ac.uk
Royal London Major Trauma CentreBarts Health NHS Trust
LET’S AGREE…
LET’S AGREE…
Not everyone needs immobilisation
LET’S AGREE…
Self extrication is a thing
LET’S AGREE…
Self-splinting is a thing
LET’S ALSO AGREE…
Spine and spinal cord injuries are not a joke
LET’S ALSO AGREE…LET’S ALSO AGREE…
LET’S ALSO AGREE…
Spine and spinal cord injuries are not a joke
LET’S ALSO AGREE…
If this happens in your systemyou have a much bigger problem
LET’S NOT PRETEND…
That there is any quality evidence
LET’S NOT PRETEND…
That there is any quality evidence
It is easier to suggest harm than to prove harm
It is MUCH EASIER to suggest harm than to prove benefit
It is easier to suggest harm than to prove harm
It is MUCH EASIER to suggest harm than to prove benefit
Airway devices can…
Increase aspirationRaise ICPCause pressure ulcersBe uncomfortable
Airway devices can…
Increase aspirationRaise ICPCause pressure ulcersBe uncomfortable
Cervical collars can…
Increase aspirationRaise ICPCause pressure ulcersBe uncomfortable
LET’S ALSO NOT PRETEND…
We know what a world without collars looks like
28%
18%25%
12%
LIFETIME COST OF TETRAPLEGIA:$4,000,000
CERVICAL COLLAR$10
LIFETIME COST OF TETRAPLEGIA:$4,000,000
CERVICAL COLLAR$10
LET’S ALSO NOT PRETEND…
We have ever asked patients
COLLARS ARE A SIDESHOW
PROLONGED IMMOBILISATION IS THE
ABSOLUTE ISSUE
IF YOU THINK COLLARS ARE THE PROBLEM
YOUR SYSTEM IS BROKEN
IMMOBILISE HIGH-RISK ONLY
UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION
(UNLESS TRANSFERRING)
CONSCIOUS AND/OR UNSUPERVISED PATIENTGETS 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
IMMOBILISE HIGH-RISK ONLY
UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION
(UNLESS TRANSFERRING)
CONSCIOUS AND/OR UNSUPERVISED PATIENTGETS 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
IMMOBILISE HIGH-RISK ONLY
UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION
(UNLESS TRANSFERRING)
CONSCIOUS AND/OR UNSUPERVISED PATIENTGETS 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
IMMOBILISE HIGH-RISK ONLY
UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION
(UNLESS TRANSFERRING)
CONSCIOUS AND/OR UNSUPERVISED PATIENTGETS 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
IMMOBILISE HIGH-RISK ONLY
UNCONSCIOUS, SUPERVISED PATIENT DOES NOT NEED IMMOBILISATION
(UNLESS TRANSFERRING)
CONSCIOUS AND/OR UNSUPERVISED PATIENTGETS 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
SAFESIMPLE
EFFICIENTCONSISTENT
IF YOU STILL THINK COLLARS ARE A PROBLEM
DO THE RCT
28%
18%25%
12%
WHAT DO WE REALLY NEED TO CHANGE?
Related Documents
