TABLE 112.6 SIGNS AND SYMPTOMS OF CERVICAL SPINE INJURY Abnormal motor examination (paresis, paralysis, flaccidity, ataxia, spasticity, rectal tone) Abnormal sensory examination (pain, sensation, temperature, paresthesias, anal wink) Altered mental status Neck pain Torticollis Limitation of motion Neck muscle spasm Abnormal or absent reflexes Clonus without rigidity Diaphragmatic breathing without retractions Spinal (neurogenic) shock (hypotension with bradycardia) Priapism Decreased bladder function Fecal retention Unexplained ileus Autonomic hyperreflexia Blood pressure variability with flushing and sweating Poikilothermia Hypothermia or hyperthermia Management While attending to the basic ABCs of trauma resuscitation, the clinician should stabilize the cervical spine An appropriately sized hard cervical collar should be chosen The longest collar that does not hyperextend the neck is the correct choice The choice between a one-piece collar (e.g., Stifneck) and a two-piece collar (e.g., Philadelphia) is important only in that correct fit must be ensured and the provider must understand how to apply the specific brand of collar It is helpful to fold over the Velcro connectors on the collar before sliding them under the patient’s neck to avoid Velcro attachment to the child’s hair or clothing If a patient is seated and needs to have a collar placed, this maneuver should be accomplished by positioning the collar’s chin portion first, followed by the placement of the posterior portion If the patient is wearing a helmet, it should be