Management of Acute Cervical Spine Injuries

The initial management of the polytrauma patient follows the Advanced Trauma Life Support (ATLS) practice of airway and cervical spine control, breathing and circulation. Assessment of injuries takes place initially in the form of a primary survey, during which time life-threatening injuries are excluded. This is followed by a secondary survey when a more detailed assessment of injuries is carried out, including spinal injuries. All polytrauma patients should be assumed to have a cervical spinal injury until proven otherwise; precautionary cervical spine immobilisation should be instigated for all patients at the scene of the injury by pre-hospital staff. By immobilising the spine immediately, major injuries can be treated at the scene, or on arrival at hospital, without the risk of disrupting an unstable cervical spine injury and causing secondary neurological injury. 2