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Management of Cervical Spine Injuries-Primary Survey

On reaching the injured player, the primary objectives are to assess for immediately life-threatening conditions and to prevent further injury. The initial evaluation follows the ABCDE sequence of trauma care:

A, airway maintenance with cervical spine protection;

B, breathing and ventilation;

C, circulation;

D, disability (i.e., neurological status); and

E, exposure of the athlete.

During this primary survey, appropriate resuscitation procedures are instituted for any identified alteration of vital functions. The emergency medical system should be activated immediately after recognizing a life-threatening problem or serious spinal injury.

The findings of the primary survey will determine how the player is subsequently treated. In this regard, one of three clinical scenarios will become apparent.

The first—and least likely—scenario involves the life-threatening problem of actual or impending cardiorespiratory collapse. The second scenario involves the athlete with an altered mental status but no compromise of the cardiovascular or respiratory system.

In the third—and most common—scenario involves a neck-injured player with a normal level of consciousness and normal cardiopulmonary function. When selecting the appropriate management procedure for a specific scenario, the athlete’s body position on the playing surface must be taken into account as well.

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