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Management of Cervical Spine Injuries-Scenario 2: Altered Mental Status without Cardiorespiratory Compromise

Care of the cervical spine in the collision athlete with altered mental status presents a challenging problem for the sports medicine physician. After a rapid primary survey, a brief neurological assessment is performed to determine the athlete’s level of consciousness.

Important aspects of the on-field neurological examination include assessment of mental status (i.e., Glasgow Coma Scale), pupillary response, assessment of eye movements and visual fields, and gross motor and sensory examination of the extremities.

The prone athlete should be carefully log-rolled into a supine position (see Protocol for Positioning and Helmet Removal). Altered mental status is an indication for early and rapid removal of the face mask.

Complete loss of consciousness in this scenario usually is related to a closed head injury. Other causes include, but are not limited to, hypoglycemia, hyperthermia, and drug overdose. Closed head injury also may alter the athlete’s state of awareness and his or her ability to respond to questioning and/or a neurological examination.

Therefore, any athlete with altered mental status is considered to have a cervical spine injury until proven otherwise. The unconscious athlete is always assumed to have a cervical spine injury.

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