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.

Assess Blog

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

Bacteria Blog

What Bacterial Infections Are Likeliest in the Canadian Northwoods?

Electro Blog

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

Anika - Plot Twist

Anika: Rock Climbing Catastrophe

NEXUS Blog

When Should Spinal Immobilization Be Implemented Per NEXUS?

Tourniquet Blog

What Is the Best Knot for a Tourniquet?

CPR Blog

Why Does the MARCH Protocol Prioritize Respiration Before Circulation?

ACS Blog

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

George – Cutting the Nerve

George: Table Saw Disaster

W3W Blog

Is What3Words a Good Offroad Companion?

Rene – Lost

Rene: Nightmare Storm

Shick Blog

Does Neurogenic Shock Impact Blood Pressure or Blood Volume?

Jim – Vision Loss

Jim: Worksite Eye Emergency

Fluids Blog

What Does It Mean to Tolerate Fluids?

EVAC blog

How Do I Determine the Urgency and Means of Evacuation for Abdominal Issues?

MARCH Blog

What Do I Do During a MARCH Assessment?

Barry Betha – Heat Emergencies

Barry Betha: Overheated Biker Collapses

Lid Blog

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

Mary – Carnival Birth

Mary: Unexpected Carnival Delivery

Thomas – Car Accident

Thomas: Telephone Pole Collision