In an unresponsive patient with suspected cervical spine injury, what airway maneuver should you use first?

• A. Jaw-thrust with manual inline stabilization
• B. Head-tilt-chin-lift
• C. Cricoid pressure
• D. Endotracheal intubation

Answer: (A)

In a trauma patient with suspected cervical spine injury, the priority is to open the airway while keeping the neck in alignment. The jaw-thrust with manual inline stabilization achieves this: it lifts the mandible forward to clear the airway without extending or flexing the neck, and the inline stabilization protects the cervical spine during the maneuver. This makes it the safest and most effective first step to ensure ventilation without risking further spinal injury.

The head-tilt-chin-lift would require extending the neck, which can worsen cervical spine injury and is therefore inappropriate in this scenario. Cricoid pressure isn’t about opening the airway; it’s used to reduce aspiration risk during intubation and can hinder ventilation if the airway is obstructed or needs quick relief. Endotracheal intubation is a definitive airway management step, but it should follow establishing a patent airway with minimal neck movement and ongoing spine protection.