Prehospital Cervical Spine (C-spine) Stabilization and Airway Management in a Trauma Patient: A Review

Cureus, 2024 · DOI: 10.7759/cureus.54815 · Published: February 24, 2024

Simple Explanation

Spinal cord injury (SCI) involves damage to the brain-to-body signaling bundle, potentially worsening during patient handling and transport. Therefore, prehospital care is essential to minimize SCI. Prehospital care includes examining the patient, immobilizing the cervical spine (C-spine), cardiovascular support, and careful airway management, possibly with intubation using manual in-line stabilization (MILS). MILS can restrict mouth opening and laryngoscopic vision during intubation, but video laryngoscopes like Airtraq and AirWay Scope (AWS) can help improve intubation conditions and reduce C-spine extension movement.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Not specified

Key Findings

1
Prehospital care is crucial to prevent or minimize spinal cord injury (SCI) due to the potential for the injury to develop or worsen during patient handling and transportation.
2
The manual in-line stabilization (MILS) technique, used during endotracheal intubation, can limit mouth opening and compromise laryngoscopic view.
3
Video laryngoscopes like Airtraq and AirWay Scope (AWS) can improve intubation conditions and reduce C-spine extension movement compared to direct laryngoscopes.

Research Summary

Prehospital care is critical in managing trauma patients with potential cervical spine injuries (SCI) to prevent further damage during transport and handling. Airway management, including endotracheal intubation, is a crucial component of prehospital emergency treatment, with manual in-line stabilization (MILS) used to minimize C-spine movement during intubation. The review highlights the importance of correctly identifying battle casualties who have suffered spinal column or spinal cord damage, stabilize their medical condition, and immobilize them for aeromedical evacuation.

Practical Implications

Enhanced Training

Emphasize training on advanced airway techniques, focusing on maintaining oxygenation and ventilation in trauma patients.

Selective Immobilization

Implement selective spinal immobilization protocols based on clinical criteria to avoid unnecessary immobilization and associated risks.

Aeromedical Considerations

Improve identification and safety protocols for war casualties with spinal cord injury during aeromedical evacuation to prevent neurologic deterioration.

Study Limitations

1
The effectiveness of pharmacological treatments, such as methylprednisolone (MPS), for SCI in the prehospital setting is not supported.
2
Pharmaceutical drugs' effectiveness in therapeutic hypothermia for SCI is unknown.
3
Inconsistent capacity to accurately measure reduction and placement constrains halo immobilization's usefulness in combat scenarios.

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