Open Airway-Neutral Cervical Spine

We received three consecutive pediatric trauma patients on backboards and in cervical collars during a recent shift in the pediatric ED. What was obvious with all three of these patients was their lack of a neutral cervical spine. Their airways simultaneously appeared to be partially compromised as large occiputs caused cervical flexion, their chins were pushed upward, and their mouths were forced closed as the cervical collars’ chin stabilizers were scrunched against their chest walls.   The heads of children are disproportionately large compared with their bodies. The cartoonist, Charles Schulz, captured the essence of this in Charlie Brown. When placed in a supine position, a child’s relatively large head causes forward flexion of the neck on the body. This forward flexion or supine kyphosis has been described in an article by Herzenberg et al. as a cause of anterior translation of the fractured cervical spine in pediatric trauma patients. (J Bone Joint Surg Am 1989;71[1]:15.) (The movement of the fractured cervical spines demonstrated in this article was dramatic.) This neck flexion also has the potential for compromising the airway. As is currently taught in most Pediatric Advanced Life Support (PALS) courses, the open airway is best accomplished by placing padding under the shoulders of these children.   Nypaver et al. studied neutral position and defined it in their study as using enough padding under the shoulders to bring the long axis of the cervical spine...
Source: M2E Too! Mellick's Multimedia EduBlog - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs