In a patient with suspected spinal cord injury presenting with hypotension, what is the immediate priority in initial management?

• A. Stabilize cervical spine, maintain airway, and treat hypotension per protocol (avoid neck movement; immobilize).
• B. Administer corticosteroids as soon as possible.
• C. Obtain an emergency MRI of the spine before any movement.
• D. Begin physical therapy to prevent deconditioning.

Answer: (A)

Protecting the spinal cord while supporting vital functions is the immediate priority. In a suspected spinal cord injury with hypotension, the first actions are to immobilize the cervical spine, secure the airway, and treat hypotension per protocol. Keeping the neck still prevents further injury during assessment and intervention, while ensuring an open airway and adequate oxygen delivery helps minimize secondary damage to the spinal cord. Hypotension compromises spinal cord perfusion, so promptly restoring circulatory status with isotonic fluids (and using vasopressors if needed per protocol) is essential to protect neurologic function. Imaging or definitive therapies are important but come after stabilization, so delaying movement for corticosteroids, MRI, or rehab is not appropriate in the initial phase.