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trauma
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ED Airway with C-Spine Protection in Trauma
Trauma RSI and definitive airway management with manual in-line stabilization
Definitive airway in suspected cervical-spine trauma requires preoxygenation, manual in-line stabilization, modified RSI, and a primary plan with explicit rescue — failed oxygenation causes more harm than controlled cervical motion.
If you forget
MILS, not collar removal — second provider holds the head manually.
Board trap
"Are you removing the hard collar?" No — MILS is ADDED, the collar stays or is opened anteriorly; oxygenation and first-pass success take priority over zero motion.
Key numbers
- Preoxygenation: 100% FiO2 × 3-5 min OR 8 vital-capacity breaths
- Maintain SpO2 ≥ 90-94% and SBP ≥ 100-110 mmHg — hypotension and hypoxemia are high-consequence omissions
- ≤ 3 laryngoscopy attempts before rescue progression (per ASA limits on attempts)
- FONA/cricothyroidotomy after failed intubation + failed ventilation
- MILS reduces but does not eliminate cervical segmental motion during laryngoscopy
Reviewed Sep 15, 2026 for clinical accuracy by BoardsBridge Editorial Process
Drill this as a SOE stem →Uri Rozen, MD — Licensed Physician, Israel
Source guidelines: DAS Cervical Spine Airway 2024 · ACS TQP TBI Best Practices 2024 · ASA Difficult Airway 2022
Re-review cadence: 12 months from reviewed date.
Related on BoardsBridge
Card ID: ed-airway-cspine · Path: aba.trauma.primary-survey-resuscitation.ed-airway-cspine