In a casualty with suspected cervical spine injury who is unconscious, what airway management approach is preferred?

• A. Perform a cricothyrotomy immediately to secure airway.
• B. Secure airway with inline cervical spine stabilization, typically via endotracheal intubation if feasible.
• C. Allow spontaneous ventilation without intervention to avoid movement.
• D. Nasopharyngeal airway only.

Answer: (B)

When a casualty is unconscious with a suspected cervical spine injury, the priority is to secure a definitive airway without moving the neck. The best approach is to perform endotracheal intubation while maintaining manual inline cervical spine stabilization so the head and neck are kept in alignment during the airway procedure. This protects the spine from movement that could worsen injury, while establishing a secure, protected airway for ventilation and oxygenation. Techniques that minimize neck extension, such as using an appropriate airway device with careful alignment or a video laryngoscope if available, help achieve this balance between airway control and spinal protection. If intubation is successful, the airway is secured and cervical precautions can continue. If intubation cannot be accomplished or is unsafe, escalate to a surgical airway rather than abandoning spinal protection. Nasopharyngeal airways are avoided in this scenario because they do not provide a definitive airway and carry risks in suspected skull or basal skull fractures.