
Contents
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Introduction Introduction
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Treatment Treatment
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Step by Step Step by Step
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1. Evaluate the patient to ensure adequate oxygenation, ventilation, airway patency, and spontaneous ventilation. 1. Evaluate the patient to ensure adequate oxygenation, ventilation, airway patency, and spontaneous ventilation.
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2. Ensure adequate IV access. 2. Ensure adequate IV access.
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3. Manage hemodynamics; monitor for spinal or neurogenic shock. 3. Manage hemodynamics; monitor for spinal or neurogenic shock.
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4. Prepare airway equipment and select method of intubation. 4. Prepare airway equipment and select method of intubation.
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5. Remove ONLY the anterior portion of the cervical collar and apply MILS. 5. Remove ONLY the anterior portion of the cervical collar and apply MILS.
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6. Preoxygenate and give induction medications. 6. Preoxygenate and give induction medications.
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7. Perform direct or indirect laryngoscopy and intubation. 7. Perform direct or indirect laryngoscopy and intubation.
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8. Preoxygenate patient and prepare equipment. 8. Preoxygenate patient and prepare equipment.
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9. Consider sedation.,, 9. Consider sedation.,,
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10. Topicalize the airway. 10. Topicalize the airway.
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11. Perform awake intubation. 11. Perform awake intubation.
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12. Transfer of care and decision to extubate. 12. Transfer of care and decision to extubate.
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Other Management Considerations Other Management Considerations
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References References
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20 C20Management of the Unstable Cervical Spine
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Published:September 2023
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Abstract
Spinal cord injury can occur due to trauma or secondarily by maneuvering the pathologic spine. Damage can be exacerbated when manipulating the airway with intubating devices, as well as with bag-mask ventilation. Remain cautious, even when a cervical collar is in place, as the spinal cord integrity is still at risk. Despite decades of research on cervical column stability with the use of airway devices, there remains no clear evidence that supports the use of one device over the other. However, use of manual in-line stabilization has stood the test of time in rapidly providing safe intubating conditions. If time allows, a properly performed awake fiberoptic intubation is the preferred method if the patient is calm and cooperative. Myriad other injuries can be associated with traumatic cervical spine injuries. One must have comprehensive knowledge of these to predict complications and treat accordingly. If the integrity of the spinal cord is disrupted, neurogenic and spinal shock can be an acute threat to life.
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