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    Intubation of the Patient with a Suspected Spinal Cord Injury

    Critical Care / Resuscitation, Respiratory

    Last Updated Oct 01, 2018
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    Context

    • Traumatically injured patients with the following characteristics have a higher chance of spinal cord injury:
      –  Neck pain or neurological symptoms
      –  Altered LOC
      –  Blunt injury above the clavicles

    Management

    • During airway management, patient cervical spine should be maintained in a neutral position with the rigid cervical collar removed and manual in-line stabilization (MILS) applied.
    • MILS should be applied by another provider with hands on the sides of the patient’s head but not impairing mouth opening.
    • All airway maneuvers such as BVM, oral airway placement, cricoid or external laryngeal manipulation, and intubation with either DL or VL will cause some degree of cervical spine movement. This is usually in the order of 2-4mm.
    • Care should be taken to maintain neutral spine positioning and not place the patient in the classic “sniffing” position with full extension of the atlanto-axial joints and flexion of the lower cervical vertebrae.
    • Treat all airway management of patients with suspected spine injury as difficult and prepare accordingly.
    • Rapid Sequence Intubation and your airway device (Direct or Video Laryngoscopy) of choice is often safe.
    • Routine use of the bougie is recommended.
    • Succinylcholine should be used with caution in patients with potential spinal cord injury unless it has been less than 24-48 hours.

    Quality Of Evidence?

    Justification

    Consensus opinion by airway management experts with reasonable studies to support.

    Moderate

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