June 16, 2021

REBEL Core Cast 59.0 – C-Spine Intubation

Take Home Points

  • Neck movement (both extension and flexion) has the ability to cause cord damage.
  • Using hyperangulated blade in video laryngoscopy improves chances for glottic visualization in patients with a c-collar in place.
  • Ultimately, hypoxemia kills – Intubate the patient with what you have available, as there has not been shown to be a definitively superior technique.

REBEL Core Cast 59.0 – C-Spine Intubation

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Read More

  1. Austin N et al. Airway Management in Cervical Spine Injury. Int J Crit Illn Int Sci 2014. PMID: 24741498
  2. Ching RP et al. The Effect of Post-Injury Spinal Position on Canal Occlusion in a Cervical Spine Burst Fracture Model. Spine (Phila Pa 1976) 1997. PMID: 9259780
  3. Crosby ET. Airway Management in Adults After Cervical Spine Trauma. Anesthesiology 2006. PMID: 16732102
  4. Ezri T et al. Difficult Airway management Practice Patterns Among Anesthesiologists Practicing in the United States: Have We Made Any Progress? J Clin Anesthesiology 2003. PMID: 14652117
  5. Holley J et al. Airway Management in Patients with Unstable Cervical Spine Fractures. Ann Emergency Med 1989. PMID: 2817569
  6. Houde B et al. A Comparison of Cervical Spine Motion During Orotracheal Intubation with the Trachlight(r) or the Flexi bee Fiberoptic Bronchoscope. Anesthesiology Analg 2009. PMID: 19372349
  7. Jenkins K et al. Management Choices for the Difficult Airway by Anesthesiologists in Canada. Can J Anaesth 2002. PMID: 12374715
  8. Lennarson PJ et al. Cervical Spinal Motion During Intubation: Efficacy of Stabilization Maneuvers in the Setting of Complete Segmental Instability. J Neurosurg 2001. PMID: 11302629
  9. Meschino A et al. The Safety of Awake Tracheal Intubation in Cervical Spine Injury. Can J Anaesth 1992. PMID: 1544191
  10. Rhee KJ et al. Oral Intubation in the Multiply Injured Patient: The Risk of Exacerbating Spinal Cord Damage. Ann Emerg Med 1990. PMID: 2331094
  11. Rosenblatt WH et al. Practice Patterns in Managing the Difficult Airway by Anesthesiologists in the United States. Anesthesiology Analg 1998. PMID: 9661565
  12. Scanell G et al. Orotracheal Intubation in Trauma Patients with Cervical Fractures. Arch Sur 1993. PMID: 8343063
  13. Suderman VS et al. Elective Oral Tracheal Intubation in Cervical
    Spine-Injured Adults. Can J Anaesth 1991. PMID: 1914066
  14. Wright SW et al. Cervical Spine Injuries in Blunt Trauma Patients Requiring Emergent Endotracheal Intubation. Am J Emerg Med 1992. PMID: 1586400

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)

Cite this article as: Anand Swaminathan, "REBEL Core Cast 59.0 – C-Spine Intubation", REBEL EM blog, June 16, 2021. Available at: https://rebelem.com/rebel-core-cast-59-0-c-spine-intubation/.
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Anand Swaminathan

Clinical Assistant Professor of Emergency Medicine at St. Joe's Regional Medical Center (Paterson, NJ)
REBEL EM Associate Editor and Author
1 Comment
  • Thomas Alterman
    Posted at 09:33h, 20 June Reply

    One of the podcasters recommended HFNC over BVM. I understand that BVM transmits more energy to the c-spine, but with HFNC don’t we fail to ventilate the patient, thereby promoting acidosis? I had been under the belief that acidosis is a major contributor to peri-intubation mortality (https://emcrit.org/emcrit/hop-mnemonic/)

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