In acute TBI care, how is cervical spine protection implemented during airway management?

• A. Proceed with airway management without cervical spine stabilization.
• B. Spinal immobilization with a cervical collar and in-line stabilization during airway management until imaging confirms stability.
• C. Remove the collar during airway management.
• D. Delay airway management until imaging confirms stability.

Answer: (B)

In acute traumatic brain injury care, protecting the cervical spine during airway management is essential because any neck movement can convert a potential injury into a spinal cord problem. The safest approach is to keep the patient immobilized with a cervical collar and use in-line stabilization of the head and neck throughout the airway procedure. This means the clinician performing intubation or suctioning maintains the neck in alignment and avoids movements like flexion, extension, or rotation. The airway can be secured while the immobilization remains in place, and imaging (such as a CT scan) is obtained promptly to assess stability. Once imaging confirms stability, immobilization can be adjusted as appropriate. Removing the collar during airway management or delaying airway until imaging confirms stability are not preferred because they increase the risk of cervical movement during a critical moment when the airway must be secured to protect oxygenation and overall brain perfusion.