Early management of head injury: summary of updated NICE guidance

As an anaesthetic trainee, I would like to raise the issue regarding clearing the immobilised (cervical) spine in an intubated or unconscious patient as there is no specific consensus in this area that exists.

I understand this article is primarily interested in the early management of a head/cervical spine injury but prolonged immobilisation and use of a cervical collar are associated with many problems including death secondary to necrotic pressure sores in the occipital, sacral and heel areas. The risks of prolonged immobilsation could potentially outweigh a serious missed cervical spine injury. [1]

As no single investigation will completely exclude a cervical spine injury. Clinicians must decide what investigation, or combination of investigations, provides them with enough evidence to either diagnose a cervical spine injury or exclude it. [2] As no consensus exists, and local guidelines that are being produced with inevitable variation I think a good place for a national guideline in this specific area would be in these particular NICE head injury guidelines.

I look forward to discussion on what I predict is a topic of much interest to those involved in the management of immobilsed patients in a critical care setting.

References:
1. Morris C, McCoy W, Lavery G.
Spinal immobilisation for unconcious patients with multiple injuries.
BMJ. (2004) 329(7464): 495–499.

2. Harrison P, Cairns C.
Clearing the cervical spine in the unconsious patient
CEACCP (2008) 8 (4): 117-120.