Gunshot Wounds of the Cranium or Torso: Implications for Spinal Immobilization and Airway Management

Methods to secure the airway and immobilize the spine are undertaken immediately in the evaluation of the severely injured patient. The incidence of cervical spine injury (CSI) in patients with head injury ranges from 1.7% to 11.1%. These reports predominantly include patients with blunt trauma. However, the strategy for spinal immobilization has been taught not only for blunt injuries but also for victims of penetrating trauma, such as gunshot wounds (GSWs). According to the Advanced Trauma Life Support textbook, “Any injury above the clavicle should prompt a search for a c-spine injury.” Spinal immobilization using a rigid cervical orthosis and long backboard may have certain implications with respect to airway management. Cervical and thoracolumbosacral (TLS) immobilization has been shown to interfere with respiratory mechanics. Time spent performing immobilization may delay necessary airway interventions and prolong time to definitive care at a trauma center. We undertook this examination of the medical literature to document the likelihood of cervical and TLS spine injury in patients with GSW of the cranium or torso, assess the impact of spinal immobilization on airway interventions, and provide guidance regarding the necessity for routine spinal immobilization in the prehospital setting.