During your primary assessment of a semiconscious 30-year-old female with closed head trauma, slow breathing and a slow, bounding pulse are noted. As your partner maintains manual in-line stabilization of her head, you should:

• A. Instruct him to assist her ventilations while you perform a rapid assessment.
• B. Focus on other tasks and delay the assessment.
• C. Immediately remove the cervical collar.
• D. Transport immediately without further assessment.

Answer: (A)

In a trauma patient with suspected cervical spine injury, preserving the airway and ensuring adequate ventilation while keeping the spine immobilized is essential. The breathing is already inadequate (slow), which puts the brain at risk of hypoxia, and the heart rate may be a response to this compromise. Having your partner assist with ventilations using a bag–valve mask allows you to rapidly secure or improve ventilation without losing precious seconds to a full assessment. You can then continue a swift primary survey (airway, breathing, circulation, disability, exposure) to identify other life threats and intervene as needed, all while maintaining manual inline stabilization of the head.

Removing the cervical collar would endanger the spine, and delaying the assessment or transporting without assessing would miss treatable problems and worsen outcomes. Providing ventilations now helps stabilize the patient’s condition as you complete the rapid assessment.