<unk>  is the process by which medical professionals determine that<unk><unk>  injuries do not exist. This process can take place in the emergency department or take place in the field by appropriately trained EMS personnel. It is based on the NEXUS (National Emergency X-Radiography Utilization Study) criteria.
Excluding a<unk> <unk> l injury requires clinical judgement and training.
When a significant mechanism of injury is present, a<unk><unk>  is determined to be stable if:
There is no posterior midline<unk>  tenderness
There is no evidence of intoxication
The patient is alert and oriented to person, place, time, and event
There is no focal neurological deficit
There are no painful distracting injuries (e.g., long bone fracture)
If the patient does not meet all the above criteria then they require a three view<unk>  x-ray series, and thoracolumbar AP and lateral plain films.
If the patient has a head injury with altered sensorium, is intoxicated, or has been given potent analgesics, then the<unk><unk>  must remain immobilised until the clinical examination becomes possible.
If the patient is not expected to be clinically evaluable within 48-72 hours because of severe head or multiple injuries, they should remain immobilized until a time when such an examination is possible. A high resolution CT (1.5-2 mm slices) with sagittal reconstructions is not a viable alternative, since it does not rule out ligamentous injury leading to instability.
Neurological deficit referable to the<unk>  may require an urgent MRI scan.
Senior neurosurgeons or orthopaedic surgeons manage any detected injury. Today, most large centers have<unk>  Surgery specialists, that have trained in this field after their Orthopedic or Neurosurgical residency.
Clearing the cervical spine
Respiratory therapy
Airway management
Pressure of speech
Cranial electrical stimulation
Intracerebral hemorrhage management
Spinal analgesia
Medical ventilator