Approach to the critical patient
›First 5 minutes workflow
›Airway monitoring if drooling or stridor
›Continuous pulse oximetry if respiratory symptoms
›IV access if fever with systemic symptoms
›Early antibiotics if sepsis physiology
›Early ENT consult if airway concern
›Reassessment loop
›Pain and ROM reassessment at 30 minutes
›Neuro reassessment after analgesia
›Airway reassessment if infectious concern
Symptom control for low risk presentation
›Analgesia and spasm relief
›NSAID or acetaminophen
›Heat
›Gentle supported positioning
›Short course muscle relaxant if needed
›Activity modification
›Relative rest 24 to 48 hours
›Avoid heavy lifting and sudden neck movement
Suspected acute dystonic reaction
›Immediate treatment
›Diphenhydramine IV 50 mg once
›Consider benztropine IV 1 mg to 2 mg once
›Observe for recurrence
›Prevention and disposition planning
›Oral diphenhydramine every 6 hours for 1 to 2 days
›Avoid offending agent
›Immobilization and imaging logic
›Maintain immobilization if high risk trauma pattern
›Apply Canadian C-Spine Rule or NEXUS when eligible
›CT cervical spine if decision tool positive or unreliable exam
›Suspected deep neck infection
›CT neck with IV contrast
›Early ENT consultation
›Antibiotics per local protocol dependent
›Suspected meningitis
›Sepsis bundle as indicated
›Blood cultures before antibiotics when feasible
›CT head before LP if focal deficit or altered mental status