NEXUS Blog

When Should Spinal Immobilization Be Implemented Per NEXUS?

Question: When a head injury occurs, should spinal immobilization be immediate if the victim initially fails the focused spine assessment questions, and how does the patient’s reliability factor into this decision?

Survival Med’s Answer: The NEXUS criteria are guidelines used by healthcare providers to assess the necessity of spinal immobilization after a traumatic incident, like a motorcycle crash.

These criteria aid in identifying individuals at a low risk of significant spinal injury, potentially eliminating the need for immobilization.

The NEXUS criteria are:

  1. Absence of midline cervical tenderness
  2. No evidence of intoxication (alcohol or drugs)
  3. Normal level of alertness and mental status (AOx4)
  4. No focal neurological deficits (e.g., weakness, numbness, tingling)
  5. No distracting injuries

During assessment, you should maintain spinal immobilization until evaluation is complete.

In scenarios where the victim swiftly returns to baseline mental status and exhibits no concerning signs, the NEXUS criteria would typically indicate that spinal immobilization is unnecessary, especially if other factors are absent as well.

However, it’s crucial to recognize the unique factors of each case.

For example, in cases that combine a low risk of spinal injury plus urgent issues like hemorrhage, venomous bites or stings, cardiac problems, stroke, or potential brain bleeds, minimizing spinal immobilization may speed up evacuation and treatment for these more life-threatening issues.

Mary – Carnival Birth

Mary: Unexpected Carnival Delivery

MARCH Blog

What Do I Do During a MARCH Assessment?

Mike – Car Accident

Mike: Icy Road Wreck

Assess Blog

When Should I Perform the Primary Assessment, Secondary Assessment, & Secondary Survey?

Daniel – The Heimlich Maneuver

Daniel: Wife Chokes During Dinner

Rene – Lost

Rene: Nightmare Storm

Anika - Plot Twist

Anika: Rock Climbing Catastrophe

Electro Blog

What Should I Include as “Electrolytes” in a First Aid Kit?

Lid Blog

What’s the Best Way to Stop Bleeding from Lid Lacerations?

Shick Blog

Does Neurogenic Shock Impact Blood Pressure or Blood Volume?

Fluids Blog

What Does It Mean to Tolerate Fluids?

George – Cutting the Nerve

George: Table Saw Disaster

ACS Blog

How Do You Differentiate Between Angina and ACS in Wilderness First Aid?

CPR Blog

Why Does the MARCH Protocol Prioritize Respiration Before Circulation?

Epi Blog

Is It Safe to Use Someone Else’s Epi-Pen in Anaphylactic Situations?

Shawn – Hunting Trip

Shawn: Lost in the Fog

Thomas – Car Accident

Thomas: Telephone Pole Collision

Crashed motorcycle with blood on it

Adrian: Terrifying Crash Leads to Near-Fatal Injuries

Kenneth – Hypothermia

Kenneth: Cold Crisis in California Mountains

man-first-aid-kit-fatigues

What Should I Include in a First Aid Kit for a Cross-Country Road Trip?