Protect the cervical spine and clear the airway

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