When should a patient injured by blunt trauma be completely immobilized during primary and secondary survey?

Complete immobilization of a patient injured by blunt trauma is critical until it is certain that a spinal fracture has been excluded by diagnostic means, such as x-rays. Spinal injuries may not always be clinically apparent, and the mechanism of injury can often involve forces that compromise spinal stability. In the context of trauma care, particularly during the primary and secondary surveys, it is essential to maintain spinal immobilization to prevent any potential movement that could exacerbate an undiagnosed spinal injury.

While a neurologic exam is important in assessing for spinal cord injury, it cannot definitively rule out the presence of a fracture. Similarly, transferring the patient to definitive care does not eliminate the risk of worsening a potential spinal injury if immobilization is not maintained. Complaining of pressure sores might indicate discomfort but does not inform the safety of removing immobilization measures. Therefore, spinal immobilization should remain intact until a spinal fracture has been conclusively ruled out to ensure patient safety and minimize the risk of further injury.