NREMT Paramedic Cognitive ExamTraumaMedium
A 55-year-old male is found unresponsive with a large, rapidly expanding hematoma to his left neck after being assaulted. He has gurgling respirations, and his airway appears to be rapidly occluding. What is the most immediate priority intervention?
- AApply direct pressure to the hematoma.
- BAttempt to establish a definitive airway.
- CInitiate rapid transport to a trauma center.
- DAdminister high-flow oxygen via non-rebreather mask.
Show answer & explanationAnswer & explanation
Correct answer: B. Attempt to establish a definitive airway.
A rapidly expanding hematoma in the neck, especially with gurgling respirations and signs of airway occlusion, indicates an immediate and severe threat to the patient's airway. Establishing a definitive airway (e.g., endotracheal intubation or cricothyrotomy if intubation fails) is the absolute priority before the swelling progresses to complete obstruction.
Why the other options are wrong
- A. While bleeding control is important, direct pressure on a rapidly expanding neck hematoma can worsen airway obstruction.
- C. Transport is important, but airway management must be secured first, as complete obstruction can occur rapidly during transport.
- D. High-flow oxygen is important, but it will not resolve an anatomical obstruction caused by a rapidly expanding hematoma.
Airway Compromise in Neck Trauma
Threat to airway patency due to direct injury, swelling, or hematoma formation in the neck region, requiring immediate intervention.
- Rapidly expanding hematoma can compress the trachea.
- Gurgling respirations and stridor are warning signs.
- Definitive airway management is often required early.
Memory trick: Neck Hematoma: Airway's Alarm, Act Immediately.