During a focused secondary survey of the head and neck, what finding would prompt immobilization of the spine?

• A. Mild facial swelling
• B. Dizziness with vertigo
• C. Ear pain on one side
• D. Midline spinal tenderness, deformity, or mechanism of injury with suspicion of cervical spine injury

Answer: (D)

Protecting the cervical spine when there is potential injury is the key idea. In a focused secondary survey of head and neck, you immobilize the spine when there are signs that the neck could be fractured or unstable or when the mechanism of injury suggests high risk for cervical spine injury. Midline spinal tenderness, deformity, or a high-energy mechanism with suspicion of cervical spine injury indicate a real danger of spinal cord damage if movement occurs, so maintaining immobilization prevents secondary injury during transport and assessment and buys time for imaging and definitive care.

The other findings don’t by themselves reliably indicate a cervical spine injury. Mild facial swelling points to facial trauma, not specifically spine stability. Dizziness with vertigo can arise from many causes, including head injury or vestibular issues, and does not confirm cervical spine injury. Ear pain on one side suggests local ear or skull injury rather than spinal instability.