›Neutral alignment
›Avoid traction in atlanto-occipital dislocation
›Neuro exam documentation before and after immobilization
›Reduction indications
›Facet dislocation with neurologic deficit
›Progressive deficit with malalignment
›Threatened airway due to deformity uncommon
›Contraindications and caution triggers
›Atlanto-occipital dislocation
›No traction reduction attempts
›Immediate operative stabilization pathway
›Suspected disc herniation risk
›Consider MRI before traction in selected cases per specialist
›Analgesia and anesthesia for reduction
›Analgesia base
›Acetaminophen PO 1000 mg once
›Ibuprofen PO 400 mg once if no contraindication
›Opioid titration
›Fentanyl IV
›Initiate 0.5 micrograms per kg
›Repeat 0.25 micrograms per kg every 5 minutes as needed
›Maximum based on respiratory status
›Procedural sedation when required
›Ketamine IV
›Initiate 1 mg per kg
›Additional 0.5 mg per kg every 5 to 10 minutes as needed
›Propofol IV
›Initiate 0.5 mg per kg
›Additional 0.25 to 0.5 mg per kg every 2 to 3 minutes as needed
›Monitoring requirements
›Continuous ECG
›Continuous pulse oximetry
›Capnography
›Resuscitation airway equipment at bedside
›Closed traction reduction pathway for facet dislocation
›Specialist involvement
›Spine surgery present or immediately available
›Gardner-Wells tongs or equivalent
›Incremental weights per protocol
›Neuro exam reassessment after each increment
›Post-reduction immobilization
›Rigid collar or halo per stability
›Post-reduction CT confirmation
›Failed reduction pathway
›Persistent malalignment
›Urgent operative reduction
›Worsening neurologic exam
›Immediate cessation of traction
›Emergent MRI consideration
›Emergent decompression pathway
Open fracture medications and timing
›Open cervical fracture or penetrating injury coverage
›Cefazolin IV 2 g
›Repeat every 8 hours
›Duration per operative plan
›If severe beta-lactam allergy
›Clindamycin IV 900 mg
›Repeat every 8 hours
›Contamination escalation
›Gross contamination or farm exposure
›Add gentamicin IV 5 mg per kg once daily
›Tetanus prophylaxis
›Unknown or incomplete immunization
›Tdap IM
›Tetanus immune globulin IM
DVT prophylaxis when relevant
›Immobilized spinal injury risk
›Pharmacologic prophylaxis per trauma protocol when no contraindication
›Mechanical prophylaxis when pharmacologic contraindicated
›Timing coordinated with spine surgery and bleeding risk