Neck Pain After TraumaAPPROACH

BACK AND NECK · 19 SECTIONS

⚲

399 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Atraumatic Back Pain Sciatica And Radicular Back Pain Back Pain With Neurologic Deficit, Cauda Equina Concern Back Pain With Fever Or Immunosuppression, Spinal Infection Concern Atraumatic Neck Pain Neck Pain After Trauma Neck Pain With Meningismus Concern Acute Torticollis

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx59

HPI

›Index trauma and symptom course

›Mechanism

›Blunt trauma

›Penetrating trauma

›Energy and kinematics

›High speed MVC

›Fall height

›Protective factors

›Seatbelt use

›Helmet use

›Immediate post injury events

›Loss of consciousness

›Amnesia

›Neck immobilization history

›Prehospital collar

›Collar removed prior to ED

›Baseline neck status

›Prior chronic neck pain

›Prior limited range of motion

OPQRST

›Onset

›Time from trauma to pain onset

›Sudden versus gradual

›Provocation and palliation

›Worse with movement

›Relief with immobilization

›Quality

›Sharp

›Dull

›Region and radiation

›Midline posterior neck

›Radiation to shoulder or arm

›Severity

›Pain score 0 to 10

›Functional limitation severity

›Timing

›Constant

›Intermittent

Associated symptoms

›Neurologic symptoms

›Paresthesias

›Weakness

›Gait disturbance

›Spinal cord symptoms

›Bowel dysfunction

›Bladder dysfunction

›Head and face symptoms

›Headache

›Facial pain

›Vascular symptoms

›Vertigo

›Visual changes

›Airway and swallowing symptoms

›Dyspnea

›Dysphagia

Prior episodes and baseline function

›Prior spine injury history

›Prior cervical fracture

›Prior cervical surgery

›Baseline neurologic function

›Baseline strength

›Baseline sensation

02Alarm Features/alarm23

Immediate escalation triggers

›Time critical findings

›Airway compromise

›Rapidly progressive neurologic deficit

›Signs of high cervical cord injury

›Hemodynamic instability

High risk history features

›High risk context

›High energy mechanism

›Age 65 or older

›Anticoagulation or coagulopathy

›Known vertebral disease

High risk symptoms

›Red flag symptoms

›New focal weakness

›New numbness in extremities

›New bowel or bladder dysfunction

›Severe midline neck pain

High risk exam features

›Red flag exam findings

›Midline cervical tenderness

›Objective neurologic deficit

›Respiratory insufficiency from neuromuscular weakness

Vital sign danger patterns

›Concerning patterns

›Hypoxia

›Hypotension

›Bradycardia with hypotension

03Medications/meds13

Current medications

›Baseline medications

›Anticoagulants

›Antiplatelets

›Chronic opioids

Recent medication exposures

›Acute contributors

›Intoxicants

›Sedatives

Medication contraindications to common therapies

›Analgesic and sedative cautions

›NSAID contraindications

›Opioid and sedative respiratory risk

Allergies and intolerances

›Relevant reactions

›Contrast allergy history

›Opioid intolerance history

04Diet/diet6

Recent intake and hydration

›Intake status

›Poor oral intake

›Vomiting

Caffeine and stimulants

›Exposures

›Energy drinks

›High caffeine intake

05Review of Systems/ros17

General and infectious

›System review

›Fever

›Chills

›Weight loss

Neurologic

›System review

›Syncope

›Seizure

›Confusion

Cardiopulmonary

›System review

›Chest pain

›Dyspnea

ENT and ocular

›System review

›Vision loss

›Diplopia

GI and GU

›System review

›Urinary retention

›Incontinence

06Collateral History and Family History/chafh10

Collateral source

›Source and reliability

›EMS report

›Witness report

›Family report

Family history relevant to complications

›Vascular and connective tissue risk

›Marfan syndrome

›Ehlers Danlos syndrome

Household and exposure context

›Context

›Alcohol exposure context

›Recreational drug exposure context

07Risk Factors/rf15

Spine injury risk

›Patient factors

›Osteoporosis

›Ankylosing spondylitis

›Rheumatoid arthritis

›Prior cervical fusion

Bleeding risk

›Hemorrhage risk

›Anticoagulant use

›Platelet dysfunction

Blunt cerebrovascular injury risk

›BCVI risk context

›High energy mechanism with cervical fracture concern

›Cervical seatbelt sign with neck pain

Special populations

›Higher consequence groups

›Older adult

›Pregnancy

›Immunocompromised

08Differential Diagnosis/ddx43

Life threatening

›Cannot miss

›Cervical spine fracture or dislocation

›Midline tenderness

›Focal neurologic deficit

›Spinal cord injury

›Weakness

›Sensory level

›Epidural hematoma

›Anticoagulation

›Rapid neurologic decline

›Blunt cerebrovascular injury

›Posterior circulation symptoms

›Focal neurologic deficit

›Atlanto occipital dissociation

›High energy mechanism

›Neurologic deficits

Common

›Common traumatic causes

›Cervical strain or sprain

›Paraspinal tenderness

›Normal neurologic exam

›Whiplash associated disorder

›Neck pain with headache

›Reduced range of motion

›Cervical radiculopathy

›Dermatomal pain or paresthesia

›Myotomal weakness

Less common

›Other diagnoses

›Facet injury

›Pain with extension rotation

›Localized paraspinal tenderness

›Cervical disc herniation

›Arm pain

›Positive nerve root tension signs

›Vertebral artery dissection

›Neck pain with vertigo

›Occipital headache

Mimics and pitfalls

›Mimics

›Shoulder girdle injury

›Pain with shoulder range of motion

›Focal shoulder tenderness

›Intracranial injury referred pain

›Headache predominance

›Altered mental status

09Past Medical History/pmh10

Relevant conditions

›Baseline conditions

›Prior cervical spine disease

›Prior stroke or TIA

›Seizure disorder

Prior procedures

›Prior interventions

›Cervical spine surgery

›Epidural injections

Baseline function

›Functional baseline

›Ambulation status

›Baseline paresthesias

10Physical Exam/exam38

Initial stabilization focus

›Primary survey priorities

›Airway patency

›Breathing adequacy

›Circulation and perfusion

General and vital sign interpretation

›Global assessment

›Toxic appearance

›Pain behavior

Cervical spine exam

›Neck inspection and palpation

›Midline cervical tenderness

›Paraspinal muscle tenderness

›Step off or deformity

›Range of motion safety gating

›No active range of motion until low risk criteria met

›Stop if pain or neurologic symptoms occur

Neurologic exam

›Mental status and cranial nerves

›GCS trend

›Cranial nerve deficits

›Motor function

›Upper extremity strength

›Lower extremity strength

›Sensory function

›Dermatomal sensation

›Saddle anesthesia

›Reflexes and long tract signs

›Hyperreflexia

›Hoffmann sign

›Clonus

›Coordination and gait

›Ataxia

›Unsteady gait

Vascular and skin exam

›Perfusion and injury markers

›Carotid bruit

›Neck hematoma

›Seatbelt sign

Secondary survey

›Distracting injuries

›Long bone deformity

›Large laceration

›Significant torso tenderness

11Lab Studies/labs12

Core labs when indicated

›Baseline testing

›CBC for anemia and infection context

›Electrolytes for metabolic contributors

Coagulation and bleeding risk

›Hemostasis testing

›INR if anticoagulated or liver disease

›Platelet count if bleeding concern

Pregnancy status

›Pregnancy testing

›Beta hCG if pregnancy possible

›Imaging and medication implications

Toxicology and clearance reliability

›Intoxication context

›Ethanol level if unreliable exam

›Urine drug screen if clinically relevant

12Imaging/img43

Scoring Systems

›Clinical decision rules for imaging need

›Canadian C Spine Rule

›High risk factors

›Age 65 or older

›Dangerous mechanism

›Paresthesias in extremities

›Low risk factors permitting range of motion assessment

›Simple rear end MVC

›Sitting position in ED

›Ambulatory at any time

›Delayed onset neck pain

›No midline cervical tenderness

›Active rotation requirement

›45 degrees left

›45 degrees right

›NEXUS criteria

›No midline cervical tenderness

›No intoxication

›Normal alertness

›No focal neurologic deficit

›No painful distracting injury

MRI

›MRI cervical spine indications

›Persistent neurologic deficit with negative CT

›Suspected ligamentous injury with concerning exam

›Suspected spinal cord compression

›MRI precautions and limitations

›Implanted device compatibility

›Motion artifact in agitated patient

›CT cervical spine role

›Preferred initial imaging for high risk blunt trauma

›Evaluation of fracture and alignment

›CT angiography neck for BCVI concern

›Cervical spine fracture patterns associated with vascular injury

›Focal neurologic deficit not explained by head imaging

›CT considerations

›Radiation exposure

›IV contrast nephrotoxicity risk for CTA

Ultrasound

›POCUS adjuncts

›Soft tissue hematoma assessment

›FAST if polytrauma context

›Ultrasound limitations

›Not a cervical spine clearance modality

›Operator dependent evaluation

13Special Tests/spec9

Bedside neurologic and root maneuvers

›Provocative maneuvers when safe

›Spurling test for radiculopathy

›Upper limb tension test

Spine stability and clearance adjuncts

›Clearance process considerations

›Intoxication as unreliable exam marker

›Distracting injury as unreliable exam marker

Vascular injury screening adjuncts

›BCVI screening frameworks

›Local protocol dependent criteria

›Imaging driven confirmation with CTA

14ECG/ecg6

ECG indications in trauma related neck pain

›When to obtain

›Syncope preceding trauma

›Chest pain or palpitations

Concerning patterns

›High risk findings

›Ischemic changes

›Bradyarrhythmia with hypotension

15Assessment/ax13

Working problem list

›Traumatic neck pain

›Concern for cervical spine injury

›Need for clearance strategy selection

›Neurologic status

›Normal exam

›Abnormal exam

Risk stratification

›Clearance pathway selection

›Alert and reliable with low risk criteria

›High risk features or unreliable exam

Complications to exclude

›High consequence injuries

›Fracture or dislocation

›Spinal cord injury

›BCVI if risk features present

16Plan/plan30

First 5 minutes

›Immediate priorities

›Maintain cervical immobilization until cleared

›Continuous pulse oximetry if concerning mechanism or symptoms

›Two large bore IV if polytrauma or instability

Analgesia and symptom control

›Adult analgesia options

›Acetaminophen PO 1000 mg once

›Ibuprofen PO 400 mg once

›Ketorolac IV 15 mg once

›Morphine IV 2 mg

›Re dose every 10 minutes as needed

›Monitor respiratory status

›Muscle spasm options

›Cyclobenzaprine PO 5 mg

›Avoid in older adult delirium risk

Imaging and clearance sequencing

›Alert and reliable

›If low risk criteria and full active rotation then collar removal without imaging

›If any high risk factor then CT cervical spine

›Unreliable exam

›CT cervical spine

›Persistent concern after negative CT then MRI or specialty consultation

Consultation

›Spine specialist triggers

›Any fracture or malalignment

›Any neurologic deficit

›Trauma service triggers

›Polytrauma

›Hemodynamic instability

Reassessment loop

›Serial reassessment

›Neuro exam after analgesia

›Pain and range of motion after clearance criteria met

›New symptoms prompting escalation

17Disposition/dispo15

ICU and resuscitation level care

›ICU indications

›High cervical cord injury with respiratory compromise

›Hemodynamic instability requiring vasopressors

Inpatient admission

›Admission indications

›Cervical fracture or dislocation

›Persistent neurologic deficit

›Uncontrolled pain preventing safe mobility

Observation pathway

›Observation considerations

›Persistent midline pain with negative CT and pending MRI

›Intoxication requiring delayed clinical clearance

Discharge criteria

›Safe discharge features

›Cleared cervical spine by criteria or imaging

›Normal neurologic exam

›Pain controlled on oral regimen

›Reliable follow up and return precautions

18Discharge Instructions/di22

Copy discharge instructions

›Summary

›Neck pain after injury with evaluation for serious neck injury

›Imaging results reviewed and serious injury not found or treated

›Medications

›Acetaminophen as directed on label

›Ibuprofen as directed on label

›Avoid alcohol or sedatives with opioid pain medicine

›Activity

›Avoid contact sports until cleared by clinician

›Gentle activity as tolerated

›Follow up

›Primary care or sports medicine within 2 to 5 days

›Spine or neurology follow up if persistent numbness or weakness

›Return to ED immediately for

›New weakness

›New numbness

›Trouble walking

›Loss of bowel control

›Loss of bladder control

›Worsening severe neck pain

›Severe headache

›Fainting

19References/r15

Guidelines and decision tools

›Stiell IG et al Canadian C Spine Rule JAMA 2001

›Clinical decision rule for imaging in alert stable trauma

›High sensitivity for clinically important injury

›Hoffman JR et al NEXUS criteria NEJM 2000

›Clinical criteria to reduce unnecessary cervical imaging

›Widely validated in blunt trauma

›American College of Radiology ACR Appropriateness Criteria Acute Spinal Trauma 2024 literature search and updates

›Modality selection guidance by clinical scenario

›CT as first line imaging in high risk blunt trauma

›Eastern Association for the Surgery of Trauma Cervical spine collar clearance in the obtunded adult blunt trauma patient 2015

›Conditional collar removal after negative high quality CT in selected patients

›Local protocol dependent implementation

›Eastern Association for the Surgery of Trauma Cervical spine injuries following trauma guideline 2009

›Emphasis on early collar removal when safe

›Risk reduction for prolonged immobilization complications

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

Neck Pain After TraumaAPPROACH

BACK AND NECK · 19 SECTIONS

⚲

399 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx59

HPI

›Index trauma and symptom course

›Mechanism

›Blunt trauma

›Penetrating trauma

›Energy and kinematics

›High speed MVC

›Fall height

›Protective factors

›Seatbelt use

›Helmet use

›Immediate post injury events

›Loss of consciousness

›Amnesia

›Neck immobilization history

›Prehospital collar

›Collar removed prior to ED

›Baseline neck status

›Prior chronic neck pain

›Prior limited range of motion

OPQRST

›Onset

›Time from trauma to pain onset

›Sudden versus gradual

›Provocation and palliation

›Worse with movement

›Relief with immobilization

›Quality

›Sharp

›Dull

›Region and radiation

›Midline posterior neck

›Radiation to shoulder or arm

›Severity

›Pain score 0 to 10

›Functional limitation severity

›Timing

›Constant

›Intermittent

Associated symptoms

›Neurologic symptoms

›Paresthesias

›Weakness

›Gait disturbance

›Spinal cord symptoms

›Bowel dysfunction

›Bladder dysfunction

›Head and face symptoms

›Headache

›Facial pain

›Vascular symptoms

›Vertigo

›Visual changes

›Airway and swallowing symptoms

›Dyspnea

›Dysphagia

Prior episodes and baseline function

›Prior spine injury history

›Prior cervical fracture

›Prior cervical surgery

›Baseline neurologic function

›Baseline strength

›Baseline sensation

02Alarm Features/alarm23

Immediate escalation triggers

›Time critical findings

›Airway compromise

›Rapidly progressive neurologic deficit

›Signs of high cervical cord injury

›Hemodynamic instability

High risk history features

›High risk context

›High energy mechanism

›Age 65 or older

›Anticoagulation or coagulopathy

›Known vertebral disease

High risk symptoms

›Red flag symptoms

›New focal weakness

›New numbness in extremities

›New bowel or bladder dysfunction

›Severe midline neck pain

High risk exam features

›Red flag exam findings

›Midline cervical tenderness

›Objective neurologic deficit

›Respiratory insufficiency from neuromuscular weakness

Vital sign danger patterns

›Concerning patterns

›Hypoxia

›Hypotension

›Bradycardia with hypotension

03Medications/meds13

Current medications

›Baseline medications

›Anticoagulants

›Antiplatelets

›Chronic opioids

Recent medication exposures

›Acute contributors

›Intoxicants

›Sedatives

Medication contraindications to common therapies

›Analgesic and sedative cautions

›NSAID contraindications

›Opioid and sedative respiratory risk

Allergies and intolerances

›Relevant reactions

›Contrast allergy history

›Opioid intolerance history

04Diet/diet6

Recent intake and hydration

›Intake status

›Poor oral intake

›Vomiting

Caffeine and stimulants

›Exposures

›Energy drinks

›High caffeine intake

05Review of Systems/ros17

General and infectious

›System review

›Fever

›Chills

›Weight loss

Neurologic

›System review

›Syncope

›Seizure

›Confusion

Cardiopulmonary

›System review

›Chest pain

›Dyspnea

ENT and ocular

›System review

›Vision loss

›Diplopia

GI and GU

›System review

›Urinary retention

›Incontinence

06Collateral History and Family History/chafh10

Collateral source

›Source and reliability

›EMS report

›Witness report

›Family report

Family history relevant to complications

›Vascular and connective tissue risk

›Marfan syndrome

›Ehlers Danlos syndrome

Household and exposure context

›Context

›Alcohol exposure context

›Recreational drug exposure context

07Risk Factors/rf15

Spine injury risk

›Patient factors

›Osteoporosis

›Ankylosing spondylitis

›Rheumatoid arthritis

›Prior cervical fusion

Bleeding risk

›Hemorrhage risk

›Anticoagulant use

›Platelet dysfunction

Blunt cerebrovascular injury risk

›BCVI risk context

›High energy mechanism with cervical fracture concern

›Cervical seatbelt sign with neck pain

Special populations

›Higher consequence groups

›Older adult

›Pregnancy

›Immunocompromised

08Differential Diagnosis/ddx43

Life threatening

›Cannot miss

›Cervical spine fracture or dislocation

›Midline tenderness

›Focal neurologic deficit

›Spinal cord injury

›Weakness

›Sensory level

›Epidural hematoma

›Anticoagulation

›Rapid neurologic decline

›Blunt cerebrovascular injury

›Posterior circulation symptoms

›Focal neurologic deficit

›Atlanto occipital dissociation

›High energy mechanism

›Neurologic deficits

Common

›Common traumatic causes

›Cervical strain or sprain

›Paraspinal tenderness

›Normal neurologic exam

›Whiplash associated disorder

›Neck pain with headache

›Reduced range of motion

›Cervical radiculopathy

›Dermatomal pain or paresthesia

›Myotomal weakness

Less common

›Other diagnoses

›Facet injury

›Pain with extension rotation

›Localized paraspinal tenderness

›Cervical disc herniation

›Arm pain

›Positive nerve root tension signs

›Vertebral artery dissection

›Neck pain with vertigo

›Occipital headache

Mimics and pitfalls

›Mimics

›Shoulder girdle injury

›Pain with shoulder range of motion

›Focal shoulder tenderness

›Intracranial injury referred pain

›Headache predominance

›Altered mental status

09Past Medical History/pmh10

Relevant conditions

›Baseline conditions

›Prior cervical spine disease

›Prior stroke or TIA

›Seizure disorder

Prior procedures

›Prior interventions

›Cervical spine surgery

›Epidural injections

Baseline function

›Functional baseline

›Ambulation status

›Baseline paresthesias

10Physical Exam/exam38

Initial stabilization focus

›Primary survey priorities

›Airway patency

›Breathing adequacy

›Circulation and perfusion

General and vital sign interpretation

›Global assessment

›Toxic appearance

›Pain behavior

Cervical spine exam

›Neck inspection and palpation

›Midline cervical tenderness

›Paraspinal muscle tenderness

›Step off or deformity

›Range of motion safety gating

›No active range of motion until low risk criteria met

›Stop if pain or neurologic symptoms occur

Neurologic exam

›Mental status and cranial nerves

›GCS trend

›Cranial nerve deficits

›Motor function

›Upper extremity strength

›Lower extremity strength

›Sensory function

›Dermatomal sensation

›Saddle anesthesia

›Reflexes and long tract signs

›Hyperreflexia

›Hoffmann sign

›Clonus

›Coordination and gait

›Ataxia

›Unsteady gait

Vascular and skin exam

›Perfusion and injury markers

›Carotid bruit

›Neck hematoma

›Seatbelt sign

Secondary survey

›Distracting injuries

›Long bone deformity

›Large laceration

›Significant torso tenderness

11Lab Studies/labs12

Core labs when indicated

›Baseline testing

›CBC for anemia and infection context

›Electrolytes for metabolic contributors

Coagulation and bleeding risk

›Hemostasis testing

›INR if anticoagulated or liver disease

›Platelet count if bleeding concern

Pregnancy status

›Pregnancy testing

›Beta hCG if pregnancy possible

›Imaging and medication implications

Toxicology and clearance reliability

›Intoxication context

›Ethanol level if unreliable exam

›Urine drug screen if clinically relevant

12Imaging/img43

Scoring Systems

›Clinical decision rules for imaging need

›Canadian C Spine Rule

›High risk factors

›Age 65 or older

›Dangerous mechanism

›Paresthesias in extremities

›Low risk factors permitting range of motion assessment

›Simple rear end MVC

›Sitting position in ED

›Ambulatory at any time

›Delayed onset neck pain

›No midline cervical tenderness

›Active rotation requirement

›45 degrees left

›45 degrees right

›NEXUS criteria

›No midline cervical tenderness

›No intoxication

›Normal alertness

›No focal neurologic deficit

›No painful distracting injury

MRI

›MRI cervical spine indications

›Persistent neurologic deficit with negative CT

›Suspected ligamentous injury with concerning exam

›Suspected spinal cord compression

›MRI precautions and limitations

›Implanted device compatibility

›Motion artifact in agitated patient

›CT cervical spine role

›Preferred initial imaging for high risk blunt trauma

›Evaluation of fracture and alignment

›CT angiography neck for BCVI concern

›Cervical spine fracture patterns associated with vascular injury

›Focal neurologic deficit not explained by head imaging

›CT considerations

›Radiation exposure

›IV contrast nephrotoxicity risk for CTA

Ultrasound

›POCUS adjuncts

›Soft tissue hematoma assessment

›FAST if polytrauma context

›Ultrasound limitations

›Not a cervical spine clearance modality

›Operator dependent evaluation

13Special Tests/spec9

Bedside neurologic and root maneuvers

›Provocative maneuvers when safe

›Spurling test for radiculopathy

›Upper limb tension test

Spine stability and clearance adjuncts

›Clearance process considerations

›Intoxication as unreliable exam marker

›Distracting injury as unreliable exam marker

Vascular injury screening adjuncts

›BCVI screening frameworks

›Local protocol dependent criteria

›Imaging driven confirmation with CTA

14ECG/ecg6

ECG indications in trauma related neck pain

›When to obtain

›Syncope preceding trauma

›Chest pain or palpitations

Concerning patterns

›High risk findings

›Ischemic changes

›Bradyarrhythmia with hypotension

15Assessment/ax13

Working problem list

›Traumatic neck pain

›Concern for cervical spine injury

›Need for clearance strategy selection

›Neurologic status

›Normal exam

›Abnormal exam

Risk stratification

›Clearance pathway selection

›Alert and reliable with low risk criteria

›High risk features or unreliable exam

Complications to exclude

›High consequence injuries

›Fracture or dislocation

›Spinal cord injury

›BCVI if risk features present

16Plan/plan30

First 5 minutes

›Immediate priorities

›Maintain cervical immobilization until cleared

›Continuous pulse oximetry if concerning mechanism or symptoms

›Two large bore IV if polytrauma or instability

Analgesia and symptom control

›Adult analgesia options

›Acetaminophen PO 1000 mg once

›Ibuprofen PO 400 mg once

›Ketorolac IV 15 mg once

›Morphine IV 2 mg

›Re dose every 10 minutes as needed

›Monitor respiratory status

›Muscle spasm options

›Cyclobenzaprine PO 5 mg

›Avoid in older adult delirium risk

Imaging and clearance sequencing

›Alert and reliable

›If low risk criteria and full active rotation then collar removal without imaging

›If any high risk factor then CT cervical spine

›Unreliable exam

›CT cervical spine

›Persistent concern after negative CT then MRI or specialty consultation

Consultation

›Spine specialist triggers

›Any fracture or malalignment

›Any neurologic deficit

›Trauma service triggers

›Polytrauma

›Hemodynamic instability

Reassessment loop

›Serial reassessment

›Neuro exam after analgesia

›Pain and range of motion after clearance criteria met

›New symptoms prompting escalation

17Disposition/dispo15

ICU and resuscitation level care

›ICU indications

›High cervical cord injury with respiratory compromise

›Hemodynamic instability requiring vasopressors

Inpatient admission

›Admission indications

›Cervical fracture or dislocation

›Persistent neurologic deficit

›Uncontrolled pain preventing safe mobility

Observation pathway

›Observation considerations

›Persistent midline pain with negative CT and pending MRI

›Intoxication requiring delayed clinical clearance

Discharge criteria

›Safe discharge features

›Cleared cervical spine by criteria or imaging

›Normal neurologic exam

›Pain controlled on oral regimen

›Reliable follow up and return precautions

18Discharge Instructions/di22

Copy discharge instructions

›Summary

›Neck pain after injury with evaluation for serious neck injury

›Imaging results reviewed and serious injury not found or treated

›Medications

›Acetaminophen as directed on label

›Ibuprofen as directed on label

›Avoid alcohol or sedatives with opioid pain medicine

›Activity

›Avoid contact sports until cleared by clinician

›Gentle activity as tolerated

›Follow up

›Primary care or sports medicine within 2 to 5 days

›Spine or neurology follow up if persistent numbness or weakness

›Return to ED immediately for

›New weakness

›New numbness

›Trouble walking

›Loss of bowel control

›Loss of bladder control

›Worsening severe neck pain

›Severe headache

›Fainting

19References/r15

Guidelines and decision tools

›Stiell IG et al Canadian C Spine Rule JAMA 2001

›Clinical decision rule for imaging in alert stable trauma

›High sensitivity for clinically important injury

›Hoffman JR et al NEXUS criteria NEJM 2000

›Clinical criteria to reduce unnecessary cervical imaging

›Widely validated in blunt trauma

›American College of Radiology ACR Appropriateness Criteria Acute Spinal Trauma 2024 literature search and updates

›Modality selection guidance by clinical scenario

›CT as first line imaging in high risk blunt trauma

›Eastern Association for the Surgery of Trauma Cervical spine collar clearance in the obtunded adult blunt trauma patient 2015

›Conditional collar removal after negative high quality CT in selected patients

›Local protocol dependent implementation

›Eastern Association for the Surgery of Trauma Cervical spine injuries following trauma guideline 2009

›Emphasis on early collar removal when safe

›Risk reduction for prolonged immobilization complications

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.