For a patient with suspected cervical spine injury requiring airway management, what is the recommended approach?

• A. Maintain inline stabilization, minimize neck movement; use video laryngoscopy if possible; ensure hemodynamic stability.
• B. Extend the neck to improve exposure.
• C. Induce with rapid sequence without stabilization.
• D. Delay airway management until imaging.

Answer: (A)

In patients with suspected cervical spine injury, protecting the cervical spine while securing the airway is the priority. This means keeping manual inline stabilization and minimizing any neck movement during airway management, so the spinal canal isn’t stressed or further injured. Using a videolaryngoscope when possible is ideal because it often provides a good view of the glottis with less need to extend or rotate the neck, reducing manipulation of the cervical spine. At the same time, maintain hemodynamic stability because induction and airway instrumentation can cause drops in blood pressure or other instability; choosing agents and a technique that avoid large swings helps keep perfusion to the brain and spinal cord intact. Extending the neck, attempting intubation without stabilization, or delaying airway management for imaging all increase the risk of either worsening spinal injury or hypoxia, so they’re not preferred.