Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-23T10:47:57.440Z Has data issue: false hasContentIssue false
  • English
  • Français

Effect of Spinal Immobilization on Heart Rate, Blood Pressure and Respiratory Rate

Published online by Cambridge University Press:  25 March 2013

Stevan R. Bruijns ,
Henry R. Guly  and
Lee A. Wallis
Stevan R. Bruijns*
Affiliation:
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa Department of Emergency Medicine, Derriford Hospital, Plymouth, United Kingdom
Henry R. Guly
Affiliation:
Department of Emergency Medicine, Derriford Hospital, Plymouth, United Kingdom
Lee A. Wallis
Affiliation:
Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
*
Correspondence: Stevan R. Bruijns, FCEM Emergency Department Derriford Hospital Plymouth, PL6 8RY, United Kingdom E-mail [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Vital signs remain important clinical indicators in the management of trauma. Tissue injury and ischemia cause tachycardia and hypertension, which are mediated via the sympathetic nervous system (SNS). Spinal immobilization is known to cause discomfort, and it is not known how this might influence the SNS and contribute to abnormal vital signs.

Hypothesis

This study aimed to establish whether the pain and discomfort associated with spinal immobilization and the maneuvers commonly used in injured patients (eg, log roll) affect the Heart rate (HR), Systolic Blood Pressure (SBP) and Respiratory rate (RR). The null hypothesis was that there are no effects.

Methods

A prospective, unblinded, repeated-measure study of 53 healthy subjects was used to test the null hypothesis. Heart rate, BP and RR were measured at rest (five minutes), after spinal immobilization (10 minutes), following log roll, with partial immobilization (10 minutes) and again at rest (five minutes). A visual analog scale (VAS) for both pain and discomfort were also collected at each stage. Results were statistically compared.

Results

Pain VAS increased significantly during spinal immobilization (3.8 mm, P < .01). Discomfort VAS increased significantly during spinal immobilization, after log roll and during partial immobilization (17.7 mm, 5.8 mm and 8.9 mm, respectively; P < .001). Vital signs however, showed no clinically relevant changes.

Discussion

Spinal immobilization does not cause a change in vital signs despite a significant increase in pain and discomfort. Since no relationship appears to exist between immobilization and abnormal vital signs, abnormal vital signs in a clinical situation should not be considered to be the result of immobilization. Likewise, pain and discomfort in immobilized patients should not be disregarded due to lack of changes in vital signs.

BruijnsS, GulyH, WallisL. Effect of Spinal Immobilization on Heart Rate, Blood Pressure and Respiratory Rate. Prehosp Disaster Med. 2013;28(2):1-5.

Keywords

blood pressurediscomfortheart ratehemorrhagepainrespiratory ratespinal immobilizationtraumavital signs
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 28 , Issue 3 , June 2013 , pp. 210 - 214
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Kohn, MA, Hammel, JM, Bretz, SW, Stangby, A. Trauma team activation criteria as predictors of patient disposition from the emergency department. Acad Emerg Med. 2004;11(1):1-9.CrossRefGoogle ScholarPubMed
2.Committee on Trauma. Advanced Trauma Life Support Provider's Manual, 7th ed.Chicago: American College of Surgeons; 2005.Google Scholar
3.Brasel, KJ, Guse, C, Gentilello, LM, Nirula, R. Heart rate: is it truly a vital sign. J Trauma. 2007;62(4):812-817.Google ScholarPubMed
4.Foex, BA. Systemic responses to trauma. Br Med Bull. 1999;55(4):726-743.CrossRefGoogle ScholarPubMed
5.Pickering, AE, Boscan, P, Paton, JFR. Nociception attenuates parasympathetic but not sympathetic baroreflex via nk1 receptors in the rat nucleus tractus solitarii. J Physiol. 2003;551(2):589-599.CrossRefGoogle Scholar
6.Hamunen, K, Kontinen, V, Hakala, E, Talke, P, Paloheimo, M, Kalso, E. Effect of pain on autonomic nervous system indices derived from photoplethysmography in healthy volunteers. Br J Anaesth. 2012;108(5):838-844.CrossRefGoogle ScholarPubMed
7.Hsieh, J, Ståhle-Bäckdahl, M, Hägermark, O, Stone-Elander, S, Rosenquist, G, Ingvar, M. Traumatic nociceptive pain activates the hypothalamus and the periaqueductal gray: a positron emission tomography study. Pain. 1966;64(2):303-304.CrossRefGoogle Scholar
8.Bantel, c, Trapp, S. The role of the autonomic nervous system in acute surgical pain processing – what do we know? Anaesthesia. 2011;66(7):541.CrossRefGoogle ScholarPubMed
9.Kwan, I, Bunn, F. Effects of prehospital spinal immobilization: a systematic review of randomized trials on healthy subjects. Prehosp Disaster Med. 2005;20(1):47-53.CrossRefGoogle ScholarPubMed
10.Cordell, WH, Hollingsworth, JC, Olinger, ML, Stroman, SJ, Nelson, DR. Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med. 1995;26(1):31-36.CrossRefGoogle ScholarPubMed
11.Cross, DA, Baskerville, J. Comparison of perceived pain with different immobilization techniques. Prehosp Emerg Care. 2001;5(3):270-274.CrossRefGoogle ScholarPubMed
12.Lerner, EB, Billittier, AJ 4th, Moscati, RM. The effects of neutral positioning with and without padding on spinal immobilization of healthy subjects. Prehosp Emerg Care. 1998;2(2):112-116.CrossRefGoogle ScholarPubMed
13.Walton, R, DeSalvo, JF, Ernst, AA, Shahane, A. Padded vs unpadded spine board for cervical spine immobilization. Acad Emerg Med. 1995;2(8):725-728.CrossRefGoogle ScholarPubMed
14.Bauer, D, Kowalski, R. Effect of spinal immobilization devices on pulmonary function in the healthy, nonsmoking man. Ann Emerg Med. 1988;17(9):915-918.CrossRefGoogle ScholarPubMed
15.Schafermeyer, RW, Ribbeck, BM, Gaskins, J, Thomason, S, Harlan, M, Attkisson, A. Respiratory effects of spinal immobilization in children. Ann Emerg Med. 1991;20(9):1017-1019.CrossRefGoogle ScholarPubMed
16.Totten, VY, Sugarman, DB. Respiratory effects of spinal immobilization. Prehosp Emerg Care. 1999;3(4):347-352.CrossRefGoogle ScholarPubMed
17.Ay, D, Aktaş, C, Yeşilyurt, S, Sarıkaya, S, Cetin, A, Ozdoğan, ES. Effects of spinal immobilization devices on pulmonary function in healthy volunteer individuals. Ulus Travma Acil Cerrahi Derg. 2011;17(2):103-107.CrossRefGoogle ScholarPubMed
18.Hauswald, M, Hsu, M, Stockoff, C. Maximizing comfort and minimizing ischemia: a comparison of four methods of spinal immobilization. Prehosp Emerg Care. 2000;4(3):250-252.CrossRefGoogle ScholarPubMed
19.Field, A. Discover Statistics Using SPSS, 3rd ed.London: SAGE Publications; 2009.Google Scholar
20.Lord, B, Woolard, M. The reliability of vital signs in estimating pain severity among adult patients treated by paramedics. Emerg Med J. 2011;28(2):147-150.CrossRefGoogle ScholarPubMed
21.Marco, CA, Plewa, MC, Buderer, N, Hymel, G, Cooper, J. Self-reported pain scores in the emergency department: lack of association with vital signs. Acad Emerg Med. 2006;13(9):974-979.CrossRefGoogle ScholarPubMed
22.Bendall, JC, Simpson, PM, Middleton, PM. Prehospital vital signs can predict pain severity: analysis using ordinal logistic regression. Eur J Emerg Med. 2011;18(6):334-339.CrossRefGoogle ScholarPubMed
23.Smith, T. Fundamentals of Anaesthesia, 3rd ed.Cambridge: Cambridge University Press; 2009.CrossRefGoogle Scholar
24.Virtanen, R, Jula, A, Salminen, JK, et al. Anxiety and hostility are associated with reduced baroreflex sensitivity and increased beat-to-beat blood pressure variability. Psychosom Med. 2003;65(5):751-756.CrossRefGoogle ScholarPubMed
25.Watkins, LL, Blumenthal, JA, Carney, RM. Association of anxiety with reduced baroreflex cardiac control in patients after acute myocardial infarction. Am Heart J. 2002;143(3):460-466.CrossRefGoogle ScholarPubMed
Supplementary material: File

Bruijns Supplementary Material

Table 3

Download Bruijns Supplementary Material(File)
File 14.4 KB