Cervical spine trauma

CERVICAL SPINE TRAUMA

After stabilization of cervical spine, next step is to assess the airway. - Unstable lesions above 3rd cervical vertebra can cause immediate paralysis, and lower cervical lesions can damage the phrenic nerve. - Cervical spine injuries can be associated with oral maxillofacial trauma, hemorrhage in the retropharyngeal space, and significant airway and neck edema; all could prevent adequate landmark visualization during intubation. - Hypopneic and hypoxic pt requires emergency airway access. - Orotracheal intubation with rapid-sequence intubation is the preferred way to establish an airway unless there is significant facial trauma.  Four people are required for this procedure:

One manually stabilizes the patient: requires firmly holding either side of the patient’s head, with the neck midline and on a firm surface, without applying traction. This prevents neck flexion or rotation during intubation  One administers induction anesthesia,  One applies cricoid pressure to prevent passive regurgitation until endotracheal tube placement is confirmed, and  One places the endotracheal tube. - A difficult intubation kit should be available in case the attempt is unsuccessful. - Laryngeal mask placement is a temporary measure to stabilize the patient until another airway can be established if orotracheal intubation fails. - Nasotracheal intubation—blind procedure— contraindicated in apneic/hypopneic patients. It is also contraindicated if the patient has a basilar skull fracture as such fractures are associated with a risk of cribriform plate disruption, which could lead to inadvertent intracranial passage of the tube. - Due to the risk of carbon dioxide retention, needle cricothyroidotomy is not ideal in patients with head injury who might require hyperventilation to prevent or treat intracranial hypertension. However, it is preferred to surgical cricothyroidotomy in children age <12 as it is easier to perform anatomically. - Tracheostomy— no longer a first option for establishing an airway due to its complications. Surgical cricothyroidotomy is preferred over surgical tracheostomy but should be converted to formal tracheostomy in 5-7 days if prolonged airway control is needed. Prolonged use of cricothyroidotomy has a high incidence of tracheal stenosis.