NREMT Paramedic Cognitive ExamTraumaHard
A 50-year-old male is involved in a high-speed rollover motor vehicle collision. He is unresponsive, GCS 3, with snoring respirations. He has significant facial trauma and a suspected cervical spine injury. What is the most appropriate initial airway management strategy?
- AHead-tilt, chin-lift maneuver.
- BNasopharyngeal airway insertion.
- CCricothyrotomy.
- DOrotracheal intubation with in-line stabilization.
Show answer & explanationAnswer & explanation
Correct answer: D. Orotracheal intubation with in-line stabilization.
In a patient with severe traumatic brain injury (GCS 3), snoring respirations (indicating airway obstruction), significant facial trauma, and a suspected cervical spine injury, definitive airway management is crucial. Orotracheal intubation with in-line cervical spine stabilization provides the most secure and controlled airway while minimizing cervical spine movement. Facial trauma may preclude bag-mask ventilation or NPA use.
Why the other options are wrong
- A. Head-tilt, chin-lift is contraindicated with suspected cervical spine injury.
- B. A nasopharyngeal airway may not be effective for complete obstruction and is contraindicated with severe facial trauma due to potential for intracranial insertion.
- C. Cricothyrotomy is a surgical airway and is typically reserved for failed intubation attempts or complete upper airway obstruction that cannot be managed by other means, not as a primary initial strategy.
Traumatic Airway Management
Establishing and maintaining a patent airway in a trauma patient, often complicated by facial trauma, cervical spine injury, or altered mental status.
- Prioritize airway patency and protection.
- Maintain cervical spine immobilization.
- Orotracheal intubation is often definitive for severe TBI.
Memory trick: C-Spine, Facial Trauma: Intubate Immediately.