Cervical spine fractures are rare and difficult to diagnose in an infant. Unique problems are to be considered in the stabilization of infants with this type of injury.
Considerations for diagnosis of a spinal injury, effective stabilization techniques and implications for aeromedical transport are illustrated in this case history.
A prospective crossover study evaluated two methods of securing an endotracheal tube: tape with benzoin and a commercial tube holder. Of 16 patients (49%) in the tape group, five (31%) were successful and 11 failed, requiring digital stabilization. Of these 11, eight then received the tube holder in the crossover design and seven (88%) were successful. Of seventeen patients in the tube holder group, 16 (94%) were successful.
The tape and benzoin method failed frequently in the presence of fluid about the face, while the tube holder worked well in these same patients. Gloves were worn successfully more frequently with the tube holder, but still were only used in 41% of the cases. For the successful applications, it took a mean of 74 seconds to apply the tape and 29 seconds to apply the tube holder (p=.029).
The tube holder is significantly better than tape with benzoin. It can be applied faster and has a higher success rate, even in the presence of fluid about the face. It can be applied more frequently with gloves on. This is important in the prevention of disease in the care-giver. We recommend its use for aeromedical pre-hospital intubations, and its testing in all pre-hospital intubations.
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