Advanced Trauma Life Support ATLS Student Course Manual 2018

GENERAL MANAGEMENT 143
them to the ED. Prevent spinal movement of any
patient with a suspected spine injury above and
below the suspected injury site until a fracture is
excluded. This is accomplished simply by laying
the patient supine without rotating or bending the
spinal column on a firm surface with a properly
sized and placed rigid cervical collar. Remember to
maintain spinal motion restriction until an injury
is excluded. Occasionally patients present to the ED
without a c-collar, in which case the treating physician
should follow clinical decision-making guidelines to
determine the need for cervical spine imaging and rigid
collar placement.
Clinicians should not attempt to reduce an obvious
deformity. Children may have torticollis, and elderly
patients may have severe degenerative spine disease
that causes them to have a nontraumatic kyphotic
deformity of the spine. Such patients should be left
in a position of comfort, with movement of the spine
restricted. Similarly, a cervical collar may not fit
obese patients, so use bolsters to support the neck.
Supplemental padding is often necessary. Attempts
to align the spine to aid restriction of motion on the
backboard are not recommended if they cause pain.
A semirigid collar does not ensure complete motion
restriction of the cervical spine. Supplementation
with bolsters and straps to the long spine board is
more effective. However, the use of long spine boards
is recommended for extrication and rapid patient
movement (see EMS Spinal Precautions and the use of
the Long Backboard: Position Statement by the National
Association of EMS Physicians and American College
of Surgeons Committee on Trauma).
The logroll maneuver is performed to evaluate
the patient’s spine and remove the long spine board
while limiting spinal movement. (n FIGURE 7-10; also see
A
B
C
D
n FIGURE 7-10 Four-Person Logroll. At least four people are needed for logrolling a patient to remove a spine board and/or examine the
back. A. One person stands at the patient’s head to control the head and c-spine, and two are along the patient’s sides to control the body
and extremities. B. As the patient is rolled, three people maintain alignment of the spine while C. the fourth person removes the board and
examines the back. D. Once the board is removed, three people return the patient to the supine position while maintaining alignment of
the spine.
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