If you're seeing this message, it means we're having trouble loading external resources on our website.

If you're behind a web filter, please make sure that the domains *.kastatic.org and *.kasandbox.org are unblocked.

Main content
Current time:0:00Total duration:10:38

Cervical spine protection in airway management (not a substitute for formal training)

Video transcript

hi this is dr. Mahadevan of Stanford University School of Medicine I'm here with my good friend south on ok and we're following up to our earlier discussions about cervical spine injuries or neck injuries and we're going to talk about some of the things you might do to manage a patient who might have a cervical spine injury in the case that you had to do something invasive like manage their airway right which is a manager there might be something stuck in their airway or blocking their airway usually the tongue falls back and blocks the airway but you're right if your airway is blocked you can't get air to your lungs and if you can't get air of your lungs you die right and we said usually your tongue falls back that's like like normal what are you talking about like that's when you're unconscious the the musculature the muscles that control your tongue relax right because you're unconscious your tongue falls back exactly and it falls back into your pharynx which is opposed to your part of your throat their eye right right and that blocks the air from either going through either through your mouth your nose into your trachea and then into your lung really so someone's just unconscious and they fall back like that they could just not that would cause them to stop breathing that would obstruct their ability to breathe and so even if they were trying to breathe they wouldn't be able to move as much air into the whole case okay okay so could it could be literally something as simple as moving the tongue out of the way exactly and that's really what these first two diagrams show the one with young boy there is showing a technique called the head tilt chin lift head tilt okay so this is he's laying down they're pushing on his okay they're pushing on that hand down on the top of his head and then lifting up there exactly and in doing so and sort of tilting the head and pulling the chin up what you're effectively doing is pulling that tongue out of the way and opening the airway so air can get into your lungs I see and and this is a little off-topic but where did you get these pictures these are actually pictures of my children yeah I thought I thought he was joking because they're clearly drawing so I thought he lived in some type of animated reality but no apparently they are your children that's my son Aditya on the left and my daughter Lavanya on the right okay so someone traced them afterwards they know they aren't absolutely a very excellent medical illustrator change them from pictures into okay okay so sorry that was off-topic and so the head-tilt chin-lift but as we talked about earlier if you had a spine injury moving the neck or tilting the head could potentially cause an injury and so in trauma victims right we tend to avoid using this particular technique and we use the one there on the right I see I see because they might be right something might have happened to their spine or their neck and the last thing you want to do is turn their neck or flex or extend I see right because this is this is going to put a little pressure on the neck around that area exactly exactly and the bones can move and if the bones move right I can injure this one this is he or the the whoever this person whose hands these are my wife's hands it's a family affair uh and so what what is what is she doing exact she's doing a maneuver which we would use in someone who potentially could have an injury to the neck called the jaw thrust and essentially what she's doing is she's grasping the angle of the mandible right exactly right they're kind of like little 90-degree angle that we have and pulling that mandible forward and in doing that what she's doing is she's doing the same thing as the head tilt chin lift just she's not flexing the neck or extended neck so you're kind of just moving the jaw as opposed to everything else and in moving the jaw you're pulling that tongue forward and opening the airway I see because the tongue is in there and right so it's okay that makes sense and so this is the technique that we use for trauma victims right right and the reason that this is important is really shown in the in the x-rays and what you see is is the same person and in the first x-ray you can see as we talked about earlier their spine is well aligned so if you were to check their alignment and your vertebral body line yeah I'm an expert at this poster for tebow body line spinal laminar line and spinous process line all look fine in this particular circumstance but what you can see is if you remove the lines you can see that there is a small fracture right right there exactly and right in front of that fracture there's a bunch of swelling all that stuff right there is your soft tissue so they're swollen and what you can't see is that that your whole cervical spine is held together by ligaments and sometimes they can be torn right and you may not be able to see them on the x-ray I see how did you know they were swelling here if you look at the x-ray you can see that the distance between the front of the spine and the front of the soft tissues is widened than what you would normally exact exactly it's usually very small very narrow and that part of the cervical spine I see makes sense and what what you realize is if a person were to come and try to open the airway mm-hmm what happens on the next radiograph could occur so I would if they use this technique right over here exactly if they were used a head tilt chin lift and were to tilt that head bow yeah put that pressure right there exactly what could happen the next x-ray shows they push the I want to juice magenta it's easier see so they pushed that back exactly Wow okay and now if you were to draw your lines again yeah specifically to an tear you might get away with yeah but this the this one right definitely the posterior line is that normal right right and again the the key fact here is that right behind that line that you drew is your spinal cord yes which is important which is right and so one of the one of the tenets of emergency medicine and medicine in general is do no harm and here in an attempt to open the airway by this head-tilt chin-lift maneuver we potentially could do harm to the patient yes Wow Wow yeah do no harm it's a good good for commercial thumb right right the next step that we would take if just simply opening the airway wasn't adequate to get someone breathing again potentially would be to actually intubate them or insert a plastic breathing tube into their trachea and allow them to breathe in it what you can see there is the active intubation so you have heard this word intubate a lot my wife is a physician I have always here so this is literally your - inserting a tube to clear things your insuiting exerting a tube to create a passageway from the oxygen-rich atmosphere right right and directly in to your lungs and again if your tongue is falling back and you can't keep it out of the way or you vomited and you're unconscious II this would be something that part of this tube go it starts right at your mouth uh-huh and it goes all the way down so flexible to Obama soo it's a flexible tube and it would go right in between this oh yes cartilage right here so we kind of go right there exactly right through the larynx and right right there where your you've got the pointer there is where your vocal cords are and go just beyond the vocal cord right into your trachea I see exactly like that because that's where you normally have something blocking that is the connection between the oxygen-rich oh yeah after that then the oxygen can get to at least some part of your lungs you've got a tube now right you've got an airway and you can and you can give deliver oxygen to a patient through that tube I see I see and what are they doing here what are they pinching in this particular diagram what they're doing is a couple things or there's actually three people there one person who looks like they're pinching is actually putting pressure on your cartilage your cricoid cartilage and they're doing that to push back and and I'm Stan de Kloet your esophagus occlude the isazo wait what is it clearly they want to close off the esophagus because the esophagus connects the stomach the stomach is full of whatever you had oh I see so you might be continuing to fluid could be coming out and all of that so you want to I see so you want to there could be stuff coming out from the stomach right and then in that tube the esophagus run is right back here and it could come up sorry so it's how much I know this is right so exactly why right running right behind your airway right there and right by pushing back you collapse the esophagus and prevent right any what we call passive regurgitation or they're pushing this let me do this in another color they're actually pushing back and the esophagus is likely to get closed then exactly and come from the stomach that doesn't close that the trick is more rigid the trachea is a rigid structure and this is right this is the actually the first ring of the trachea is a cricoid cartilage and that's what they're pushing on my eye since it's just rigid there so when you push it closes furgus trachea can still stay open exactly exactly so there's three people one person that we talked about is giving cricoid pressure that would be that gentleman right there or a young lady the second person is actually holding the head as you can see yeah and the reason that they're doing that is for what we showed earlier they don't want that head to extend or flex so they're actually holding the person in the neutral position right to prevent that those bones potentially from right because this is you know they're going to be jiggling this thing through and if this there wasn't someone holding it it could do that same damage absolutely and when you're that guy at the top who's trying to see the vocal cords and pass the tube you don't care about anything else except for seeing the vocal cords so you might inadvertently flex the neck or excite makes sense makes sense is that also why they said as an accident no don't move the person in that type of that's exactly why I'm you again do no harm in trying to help the person by lifting them up or tilting their head or flexing their neck you potentially could brush excess probably the EMTs or whoever and then don't absolutely right and if you really had to open their airway you could use the jaw thrust maneuver right right pull their jaw forward exactly to that exact is this is we were talking about right we touched on right before this this there's other ways of doing this or there's other methods that people talk about of this this cricoid pressure is quite controversial because one of the one of the things is it's supposed to help you with this procedure and some people feel that it may not be proven to help you or it potentially can cause injury but those of us that are older or I've used this technique for a long time still stand by it okay this is what y'all teach it at the med school exactly okay sorry little hope well thank you this is this is very very useful you bet