While incidence of cervical spine injury is relatively rare at 1–6.2%, lesions above C7 can lead to respiratory distress or failure due to loss of central innervation of the phrenic nerves, and lesions above T6 can lead to neurogenic shock from loss of vasomotor tone and sympathetic innervation to the heart. Strict immobilization should be maintained, including during head and neck maneuvers, such as obtaining an airway or placement of a central venous catheter, until the cervical spine is cleared. Cervical collars should be removed as soon as safely possible because continued use of the c-collar has risks of pressure ulcers, decreased cerebral venous return, increased intracranial pressure and secondary brain injury, and difficulties with airway and central line management. Computed tomography (CT) scan will be the first-line diagnostic modality.
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