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The Great C-Collar Debate

Rob Orman, MD, Mel Herbert, MD MBBS FAAEM, Andy Buck, MBBS, and Chris Colwell, MD
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13:37
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In our February 2016 episode, we had a segment titled Do we still need the C-Collar. This caused quite a bit of debate amongst the listenership as well trauma specialists across the globe. We can’t give a definitive answer as to the utility of cervical collars, but what we can give is a ringside seat to both sides of the argument. Andy Buck and Chris Colwell are here for round two pros, cons, and ‘we don’t knows’ of the great c-collar debate.

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Philip S., M.D. -

Regarding endotracheal intubation of the patient with a C-Collar, the standard of care certainly is to remove the C-Collar to utilized direct laryngoscopy to endotracheally intubate. I have seen our residents utilize the glidescope to endotracheally intubate without removing the C-Collar. Do you have any experience with this? Furthermore, about 2 decades ago, I remember listening to Peter Rosen state at a lecture that as long as we "don't hyperextend, hyperflex, or hyper-distract the neck," we won't harm the patient during endotracheal intubation during DL in the trauma bay.

Rob O -

Hey Phillip, it's certainly possible to intubate with VL leaving the c-collar on, but in my opinion doesn't create optimal viewing conditions. Since the trauma patient is unstable (almost by definition) I would shy away from the practice of trying to finesse the intubation with collar on and make it a regular practice to remove the collar, stabilize the neck, and give yourself the best visualization conditions possible.

Melissa J. -

I had one patient rolled into the ED holding her neck with her hands, essentially her own personal C-spine immobilization. I was surprised that no one in triage had placed a collar on her, but was not surprised when she was found to have an unstable c-spine fracture. It was reassuring that the patient was awake and clearly able to protect her c-cpine, but I certainly felt better having her c-spine immobilized with a collar. I have wondered about the benefit of immobilizing everyone who on exam reports midline c-spine tenderness who came walking/talking and moving their neck every direction at the triage desk...looks like it will be continued for now.

Alison G. -

Mu husband's father, several years ago, jumped head first down a slip and slide and hit his chin on the ground. He got up and walked back to his chair and sat down, picked up his beer and when he leaned back to take a drink, immediately put his beer down, grabbed his head/neck and said to his wife "We need to go to the ER, I think my head is going to fall off". He ended up getting a Halo placed IN THE ER.

Tim V. -

Why is it called a cervical collar and not just a collar? Do we put a collar anywhere other than cervical?

Whit F., M.D. -

Hi guys. For vile self-promotion only, attached is a video showing how to build a cspine collar when your crazy, demented, tiny elderly person with a c2 fracture (1) won't stay still, (2) is too weirdly-shaped for any of the departmental collars to fit well, and (3) FREAKS OUT and whips her head back and forth if you even try to place one of those EMS collars. Hope you enjoy.

https://www.youtube.com/watch?v=RGEUvhoNxMU

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January - Hotsheet - The Great C-Collar Debate Full episode audio for MD edition 13:37 min - 11 MB - M4A