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C-spine injury clearance — MCCQE Part 1 MCQ

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ModerateTraumaC-spine injury clearanceMCCQE Part 1

33-year-old cyclist presents with neck pain after a crash. He is alert, intoxicated and has midline cervical tenderness. Which of the following is the most appropriate next step?

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Correct answer: D — Maintain immobilisation and obtain C-spine imaging

Maintain immobilisation and obtain C-spine imaging is best because intoxication and midline tenderness prevent clinical clearance. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Decision rules are designed to reduce missed unstable injury.

Reference: Canadian C-Spine Rule