Which of the following is NOT a part of the key management strategies for acute spinal cord injury?

• A. ABCs
• B. Fluids
• C. Immobilization
• D. Delayed immobilization

Answer: (D)

In acute spinal cord injury, preventing secondary injury is the focus. This means securing the airway and ensuring adequate ventilation while protecting the cervical spine with precautions, maintaining adequate perfusion to the spinal cord, and immobilizing the spine immediately to prevent any movement that could worsen injury. Fluids are used to support blood pressure and perfusion; in the acute phase, clinicians aim to keep the mean arterial pressure in the high normal range (roughly 85–90 mmHg) for several days to optimize spinal cord blood flow. Delaying immobilization is not part of the standard approach because any movement of an unstable spine can exacerbate damage. Therefore, delaying immobilization is the option that does not fit with recommended management.