New option for anterior traction of the face by using a cervical collar

This case required anteroposterior traction of the maxilla. Once none of the traditional methods could be used because of the lack of support in the chin and in the frontal region. Thus, we opted to use a cervical collar.

Uso pertinente del collarín cervical en el paciente traumático: una revisión sistemática.

Introducción y objetivo: El collarín cervical es un dispositivo que tiene como objetivo disminuir el movimiento del cuello para evitar lesiones secundarias en el manejo del paciente traumático en el ámbito prehospitalario. Mediante la realización de esta revisión sistemática se ha pretendido evaluar si la colocación del collarín cervical disminuye la movilidad del cuello en el paciente traumático, así como determinar si puede producir o evitar lesiones durante su manejo. Metodología: Revisión sistemática en base a las disposiciones PRISMA. Se elaboró un protocolo de búsqueda que se utilizó en cuatro bases de datos (Medline, Scopus, CINAHL y Web of Science) y se incluyeron ensayos clínicos y estudios observacionales publicados entre enero de 1995 y diciembre de 2014. Resultados: La revisión se realizó a partir de 10 ensayos clínicos no aleatorizados de modesta calidad metodológica: en 6 se utilizaron cadáveres con lesión cervical y en los otros 4 voluntarios sanos sin lesión cervical y un ensayo clínico aleatorizado de muestra pequeña realizado sobre cadáveres con lesión cervical. En los estudios realizados en pacientes sanos sin lesión cervical se observó que el collarín disminuía de forma significativa la movilidad del cuello frente a la no inmovilización. Por el contrario, en los estudios en los que participaban cadáveres con lesión cervical se determinó que el collarín cervical no disminuía la movilidad del cuello. Además en tres estudios se detectó un aumento de la separación intervertebral y en uno, un aumento de la presión venosa yugular. Conclusiones: Si bien la inmovilización cervical reduce la movilidad del cuello en pacientes sin lesión, este efecto no se produce en quienes presentan lesiones cervicales.

Avaliação do uso de imobili zação externa após descompressão e fusão cervical por via anterior. Revisão Sistemática

This study aims to evaluate safety and effectiveness of the use of orthesis in postoperative degenerative disorders of the cervical spine. Although widely used, there are not defined criteria for the use of cervical collars, and their importance on cervical arthrodesis. A systematic literature review was undertaken and a multicentre controlled clinical trial comprising 32 specialized services, with a total of 257 patients who met the inclusion criteria of the review. Clinical and radiographic outcomes were compared in post surgical patients that used or not rigid cervical collar during 6 to 12 weeks after surgery. The evidence available on literature, although weak, suggests that cervical collar decreases the clinical scores in first weeks after surgery. Furthermore, it does not alter the rate of fusion when used concomitantly with plaque and screws through anterior access in cervical degenerative diseases on a single anatomical level.

The Hanging/hanged Patient and Relevance to Pre-hospital Care

Death and injury from hanging is a complex situation, which requires careful and appropriate assessment and management in the pre-hospital environment. It is arguably an area of limited understanding and therefore may not be assessed and managed in the most effective manner. Most hanged/hanging patients will be found in their homes, rather than in institutions. It could be argued that due to prevalence as a suicide method, the majority of pre-hospital ambulance service staff will be responded to at least one hanged or hanging patient within their careers, thus a greater understanding will benefit both clinician and patient. Patients who attempt or achieve suicide will rarely achieve fracturing the spine and severing the spinal cord, bringing into question the requirement for the traditional cervical collar and spinal immobilisation techniques. Death from asphyxiation and carotid/vagal reflex require consideration and management as does raised ICP, which is likely to occur.

Letter to the editor : likelihood of tetraplegia after CT clearance of the cervical spine in obtunded blunt trauma patients

...the probabilistic computer simulation study by Dunham and colleagues evaluating the impact of different cervical spine management (CSM) strategies on tetraplegia and brain injury outcomes.1 Based on literature findings, expert opinion and with use of advances programming techniques the authors conclude that early collar removal without cervical spine magnetic resonance imaging (MRI) is a preferable CSM strategy for comatose, blunt trauma patients with extremity movement and a negative cervical spine computed tomography(CT) scan. Although we do not have the required expertise to comment on the applied statistical approach, we would like to comment on one of the medical assumptions raised by the authors, namely the likelihood of tetraplegia in this specific population....

Motivating blue-collar employees : a case study of the Chinese workforce

The Katz and Kahn (1978) motivational framework is an open system management theory that underscores the importance of self-regulation while stressing the significance of using continuous feedback to adapt in a rapidly changing environment. This study aims to examine Katz and Kahn’s prepositions that the implementation of a system of rule compliance, external rewards, and internalized motivation can decrease employee turnover, increase quantitative and qualitative standards of performance, and enhance cooperation and creativeness. The results among 233 Chinese employees (96.6% response rate) indicated partial support for Katz and Kahn’s motivational framework. The implication for improving the Chinese workforce, in particular blue-collar occupations, is discussed.