In the initial management of suspected spinal injury, what is the recommended first action?

• A. Manual in-line stabilization and immobilization to prevent movement
• B. Administer high-dose steroids
• C. Immediate airway management
• D. Perform imaging studies

Answer: (A)

Preventing movement of the spine is the first priority when spinal injury is suspected. The immediate action is manual in-line stabilization to keep the head, neck, and spine in a neutral alignment and prevent any flexion, extension, or rotation. Once stabilization is established, immobilize the patient with a cervical collar and a rigid backboard to maintain alignment during transport. Steroids are not routinely beneficial and can cause harm, so they are not a first action. Imaging and definitive airway management are important but should follow once spinal immobilization is secured, since moving an unstable spine for imaging or procedures without precautions can worsen injury.