NREMT Emergency Medical Technician (EMT) Cognitive ExamAirway, Respiration & VentilationHard
You are assessing a patient who was involved in a high-speed motor vehicle collision. He is unconscious and has obvious facial trauma, including a fractured nose and jaw. His respirations are noisy and gurgling. Which of the following is the most appropriate initial method for opening his airway?
- AOropharyngeal airway insertion.
- BNasopharyngeal airway insertion.
- CJaw-thrust maneuver.
- DHead-tilt, chin-lift maneuver.
Show answer & explanationAnswer & explanation
Correct answer: C. Jaw-thrust maneuver.
Given the mechanism of injury (high-speed MVC) and obvious facial trauma, there is a high suspicion of spinal injury. The jaw-thrust maneuver is the preferred method for opening the airway in trauma patients with suspected spinal injury, as it minimizes cervical spine movement. The noisy, gurgling respirations indicate an airway obstruction that needs to be addressed.
Why the other options are wrong
- A. An OPA can be used after the airway is opened, but it does not open the airway itself. Also, facial trauma, especially to the jaw, may make OPA insertion difficult or increase the risk of dislodging teeth/bone fragments.
- B. NPA insertion is contraindicated in patients with suspected facial trauma, especially nasal fractures, due to the risk of inserting the tube into the cranial vault or causing further injury/bleeding.
- D. The head-tilt, chin-lift maneuver is contraindicated in patients with suspected spinal injury due to the risk of exacerbating cervical spine damage.
Airway Management in Trauma
In trauma patients, especially those with suspected spinal injury, airway management must prioritize maintaining spinal immobilization while ensuring an open and clear airway.
- Jaw-thrust maneuver is the primary method for opening the airway in trauma with suspected spinal injury.
- Avoid head-tilt, chin-lift if spinal injury is suspected.
- Facial trauma may contraindicate NPA insertion and make OPA insertion challenging.
- Gurgling indicates secretions or blood in the airway, requiring suctioning.
Memory trick: Trauma's got a jaw, so jaw thrust, don't let the spine get crushed!