Date Published

November 22, 2013

Updated For

ALS PCS Version ALS PCS Version 5.2


Question: VSA trauma patients - chest compressions and defib is the priority for this patient. C-spine maintained manually. In this scenario, is it mandatory to apply a collar prior to a shock being delivered as the manual c-spine must be removed to deliver the shock?

CPAP- indication b/p 100 or above systolic. Contraindication is hypotension. If CPAP is applied while normotensive, can we leave the device on until they become hypotensive or we must remove when b/p drops below 100? Thanks.


 Thanks for the questions. You are absolutely correct that the priority here is defibrillation and not the application of a cervical collar.

That being said, it is very uncommon for trauma patients to present in a shockable rhythm. If you do encounter such a clinical scenario, the priority should be defibrillation however as you know from your experience, many tasks are completed simultaneously. While one paramedic is applying the pads and attaching/charging the defibrillator, the other should be attending to the airway with a BVM and doing their best to maintain C-spine immobilization and apply a collar. The difference in timing between these two interventions should be minimal.

As for CPAP, you are correct, the contraindication is hypotension. CPAP should not be applied if a patient is hypotensive. If at any time the patient becomes hypotensive, CPAP must be removed.



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