Approach to blunt traumatic cervical spine injuries Quiz: Ace Your Exams

A 27-year-old man is brought to the emergency department by emergency medical services (EMS) after being involved in a high-speed motor vehicle collision. EMS reports the patient was the restrained driver of a vehicle traveling at high speed when he struck the median with airbag deployment. The patient had neck pain at the scene and a rigid cervical collar was placed. On primary survey, the patient can speak in full sentences, although the words are slurred. Breath sounds are intact bilaterally. The patient has 2+ pulses in the upper and lower extremities with capillary refill < 2 seconds. He is freely moving his upper and lower extremities bilaterally. Glasgow coma scale (GCS) is 14 with one point subtracted due to confusion. Temperature is 37°C (98.6°F), pulse is 75/min, respirations are 15/min, blood pressure is 120/84 mmHg, and oxygen saturation is 99% on room air. The secondary survey does not reveal any obvious injuries or deformities aside from a small hematoma on the forehead. The patient does not exhibit tenderness to palpation over the cervical spine. He appears clinically intoxicated and is requesting discharge and the removal of the cervical collar. He has no significant past medical history and does not take any medications. Which of the following is the best next step in management?