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Protect the cervical spine and clear the airway

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Initial management of the cervical spine and airway in ATLS consists of:

  • protecting the cervical spine:
    • aim to prevent damage or transection of the spinal cord in case the patient has a fracture or unstable dislocation of the cervical spine
    • one member of the team holds the head in the line of the body
    • another member applies a well-fitting hard collar and immobilises the head by placing sandbags on either side of the head
    • sticky-tape is passed from one side of the bed across the forehead to the opposite side of the bed to further reduce movement of the head and neck

  • airway protection:
    • if the patient is talking naturally then there is no respiratory distress and the airway is clear, in this instance, the patient should be reassured and given oxygen via a face mask
    • if there is respiratory distress begin with basic measures:
      • blockage of the airway may be obvious, e.g. stridor or facial injury
      • blockage may be due to the tongue falling back, a foreign body, vomitus or blood
      • the airway should be cleared with suction and by pulling the jaw forward, but not by hyperextension of the head as this may damage the cervical cord
    • if a clear airway cannot be obtained, further steps to make an airway will be necessary

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The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

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