Patients with multiple trauma are frequently intubated without knowledge of the condition of the cervical spine. Regardless of the airway management technique selected, movement of the spine should be minimized. Intubation techniques for patients with possible spinal injury include nasotracheal intubation with and without bronchoscopic guidance, orotracheal intubation, transtracheal intubation, and cricothyrotomy. 5 Methods for protecting the spinal cord during orotracheal intubation to prevent further injury have been studied in cadavers. These studies have shown that manual in-line stabilization using a dedicated person to hold the head and neck in a neutral position is superior to the use of a Philadelphia collar alone. 67 and 8 During proper in-line stabilization, no traction is applied to the head and spine. Axial traction is discouraged because it can cause distraction of cervical spine fractures. 9
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