6/15/2016

HelmetRemovalPeriproceduralCare:Equipment,PatientPreparation,Monitoring&Followup

HelmetRemovalPeriproceduralCare
Author:JamesCipolla,MDChiefEditor:JonathanPMiller,MDmore...
Updated:Mar21,2016

Equipment
Providers:Atleast2providers(34isideal)shouldbepresent.
Facemaskremoval:Studieshavebeenperformedtodeterminetheidealtoolto
removethefacemaskinprehospitalandhospitalsettings. [11]Thefindingssuggest
thatacordlessscrewdriveristhesuperiortooltoremovethescrewssecuringthe
facemask. [12]However,amanualscrewdrivercanalsobeused.
Screwdrivershavebeenshowntominimizeneckmotionmorethanpipecutters,
anvilpruners,facemaskextractors,orTrainersAngels.These4toolsdoreducethe
timeneededtoremoveafacemaskunfortunately,theyalsoincreasetheamountof
motionofthecervicalspine.
Helmetremoval:Apairofscissorsisalsonecessaryforhelmetremoval. [13]Scissors
shouldbeusedtocutclothingandthelacesholdingtheshoulderpadstogether,if
present. [14,15]Exposureisoneofthebasictenetsoftraumaresuscitation.

PatientPreparation
Anesthesia
Noanesthesiaisneededforhelmetremoval.
Ifairwayinstabilityoccurs,rapidsequenceintubationshouldbeemployedtosecure
theairway.Formoreinformation,seeTrachealIntubation,RapidSequence
IntubationandTrachealIntubation,Medications.

Positioning
Thepatientshouldbeplacedsupineonalongcervicalimmobilizationboardifheor
sheisnotalreadyonone.
Minimizationofcervicalspinemotionshouldbemaintainedpriortotheinitiationof
helmetremoval. [16]

Monitoring&Followup
Helmetremoval,whenperformedproperly,doesnotcarryinherentrisks.
Themajorcomplicationofhelmetremovalisworseninganextantcervicalspine
injury.
Technique

ContributorInformationandDisclosures
Author
JamesCipolla,MDAttendingSurgeon,DepartmentofTraumatologyandCriticalCare,ProgramDirector,
SurgicalCriticalCareFellowship,StLuke'sUniversityHospitalAssociateProfessorofSurgery,Temple
UniversitySchoolofMedicineAssistantClinicalProfessorofSurgery,UniversityofPennsylvaniaSchoolof
Medicine
JamesCipolla,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofSurgeons,Societyof
CriticalCareMedicine
Disclosure:Nothingtodisclose.
Coauthor(s)
AnkitShah,MDAttendingPhysician,DepartmentofEmergencyMedicine,ReadingHospitalandMedical
Center
AnkitShah,MDisamemberofthefollowingmedicalsocieties:AmericanCollegeofEmergencyPhysicians,
SocietyforAcademicEmergencyMedicine,SocietyofCriticalCareMedicine,EuropeanSocietyofIntensive
CareMedicine
Disclosure:Nothingtodisclose.

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HelmetRemovalPeriproceduralCare:Equipment,PatientPreparation,Monitoring&Followup

SpecialtyEditorBoard
MaryLWindle,PharmDAdjunctAssociateProfessor,UniversityofNebraskaMedicalCenterCollegeof
PharmacyEditorinChief,MedscapeDrugReference
Disclosure:Nothingtodisclose.
ChiefEditor
JonathanPMiller,MDDirector,FunctionalandRestorativeNeurosurgeryCenter,AssociateProfessorof
NeurologicalSurgery,GeorgeRandConstancePLincolnEndowedChair,UniversityHospitalsCaseMedical
Center,CaseWesternReserveUniversitySchoolofMedicine
JonathanPMiller,MDisamemberofthefollowingmedicalsocieties:AlphaOmegaAlpha,American
AssociationofNeurologicalSurgeons,AmericanMedicalAssociation,CongressofNeurologicalSurgeons,
AmericanSocietyforStereotacticandFunctionalNeurosurgery,NorthAmericanNeuromodulationSociety
Disclosure:Serve(d)asadirector,officer,partner,employee,advisor,consultantortrusteefor:Medtronic
Neuromodulation.
AdditionalContributors
AndrewKChang,MDAssociateProfessor,DepartmentofEmergencyMedicine,AlbertEinsteinCollegeof
Medicine,MontefioreMedicalCenter
AndrewKChang,MDisamemberofthefollowingmedicalsocieties:AmericanAcademyofEmergency
Medicine,AmericanAcademyofNeurology,AmericanCollegeofEmergencyPhysicians,SocietyforAcademic
EmergencyMedicine
Disclosure:Nothingtodisclose.

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