Intubation for Suspected Spinal Cord Injury
Critical Care / Resuscitation, Respiratory
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.
- See image: Neck Maneuvers During Airway Management.
- 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?
High
We are highly confident that the true effect lies close to that of the estimate of the effect. There is a wide range of studies included in the analyses with no major limitations, there is little variation between studies, and the summary estimate has a narrow confidence interval.
Moderate
We consider that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. There are only a few studies and some have limitations but not major flaws, there are some variations between studies, or the confidence interval of the summary estimate is wide.
Low
When the true effect may be substantially different from the estimate of the effect. The studies have major flaws, there is important variations between studies, of the confidence interval of the summary estimate is very wide.
Justification
Consensus opinion by airway management experts with reasonable studies to support.
Related Information
Reference List
Relevant Resources
RESOURCE AUTHOR(S)
DISCLAIMER
The purpose of this document is to provide health care professionals with key facts and recommendations for the diagnosis and treatment of patients in the emergency department. This summary was produced by Emergency Care BC (formerly the BC Emergency Medicine Network) and uses the best available knowledge at the time of publication. However, healthcare professionals should continue to use their own judgment and take into consideration context, resources and other relevant factors. Emergency Care BC is not liable for any damages, claims, liabilities, costs or obligations arising from the use of this document including loss or damages arising from any claims made by a third party. Emergency Care BC also assumes no responsibility or liability for changes made to this document without its consent.
Last Updated Oct 01, 2018
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