Hi ladies and gents. I have a question to ask your expert minds. We have to do yearly inservice training for the staff at the company where I work. A colleague and I put together the packets. One of the topics was on spinal cord injury. A question in particular has drawn a lot of controversy among our staff and I am wondering what everyone here thinks.

The question is:

What is the most important thing to do initially after a spinal cord injury?

The two answers causing confusion are:

1-Stabilize the neck and spine

2-Make sure the client has a proper airway.

Now, I know it is stressed with us over and over that with anyone with a suspected spinal cord injury you need to stabilize neck and spine and not move them. My thought on this is that if a patient doesn't have a patent airway, it doesn't matter what injury to their spine there may be, they will die if they can't oxygenate. I mean, does ABC's (or ACB's now) trump spinal stability? I'd love your input!!

Aren't you supposed to address them both by modifying airway interventions? A suspected spinal injury means you do a jaw thrust instead of a head tilt for any airway issues.

This reminds me of NCLEX questions where no one can do two things at once!

Question: What good will it do to stabilize the neck and spine if the patient does not have a patent airway?

The 'answer' would be that airway is more important, but you can make/keep the airway patent and still protect the C spine...

Question: What good will it do to stabilize the neck and spine if the patient does not have a patent airway?

Right, that is what Ive been telling people! But everyone is so used to having the 'stabilize the spine' thing drummed into their heads that they automatically answer that.

I do get that you can do both, that one does not negate the other. But for the purposes of the question, we wonder what to answer. Or maybe we should just altogether change the answer choices.

It makes sense to do both at the same time. I remember from TNCC when I had to do the trauma assessment, it was drilled into me to maintain the c-spine while checking the ABCs.

Here's where I'm thinking with this one. If you immediately go for the airway without stabilizing a pt with a c-spine injury you could cause further damage to the spinal cord, which could be bad news bears if you want this patient to be breathing. Yes, absolutely checking the airway is important, but you want to make sure you aren't going to hurt the patient by doing so. Stabilize head/neck, assess airway patency, jaw thrust if needed, proceed from there...