What initial assessment steps should I take for a patient presenting with a suspected blunt neck injury?

Initial assessment steps for a patient with suspected blunt neck injury:

• On arrival, use the ABCDE prioritising sequence to assess trauma, starting with catastrophic haemorrhage, airway (with manual in-line spinal immobilisation), breathing, circulation, disability (neurological status), and exposure/environment.
• Protect the cervical spine at all times with manual in-line spinal immobilisation, especially during airway management, and avoid moving the rest of the spine.
• Assess for spinal injury by checking for significant distracting injuries, intoxication, confusion or uncooperativeness, reduced consciousness, spinal pain, motor weakness in hands or feet, altered sensation, priapism (in unconscious males), and history of spinal problems.
• If any of these risk factors are present or assessment cannot be completed, maintain full in-line spinal immobilisation.
• Use the Canadian C-spine rule to stratify risk for cervical spine injury: high-risk factors include age ≥65, dangerous mechanism (e.g., fall >1m or 5 stairs, axial load to head, high-speed collisions), or paraesthesia in limbs; low-risk factors include minor rear-end collision, sitting comfortably, ambulatory since injury, no midline tenderness, or delayed neck pain.
• If high-risk factors are present or the patient cannot actively rotate their neck 45 degrees left and right (if low-risk), maintain immobilisation and arrange urgent imaging (CT cervical spine scan within 1 hour if indicated).
• Do not remove immobilisation or request imaging if the patient has low-risk factors, is pain-free, and can actively rotate their neck 45 degrees both ways.

These steps ensure early identification and protection of potential cervical spine injuries in blunt neck trauma.

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