NREMT Paramedic Cognitive ExamTraumaMedium
A 50-year-old male is found unresponsive after being struck by a vehicle while cycling. He has significant facial trauma, including a suspected fractured mandible and avulsed teeth. Gurgling sounds are noted with each breath. His SpO2 is 88% on room air, and respirations are shallow at 8 breaths/min. Which of the following is the MOST appropriate initial airway management technique?
- AAttempt oral intubation with in-line cervical spine stabilization.
- BPerform a rapid sequence intubation (RSI) with a cricoid pressure.
- CInsertion of a nasopharyngeal airway (NPA).
- DSuction the airway and perform a jaw-thrust maneuver.
Show answer & explanationAnswer & explanation
Correct answer: D. Suction the airway and perform a jaw-thrust maneuver.
The gurgling sounds indicate fluid (blood, secretions, vomitus) in the airway, which must be cleared immediately. Given the facial trauma, a jaw-thrust maneuver is preferred over a head-tilt/chin-lift to protect the cervical spine, and it can help open the airway. Suctioning will remove the gurgling substances. These are foundational and immediate steps before considering advanced airway adjuncts or intubation.
Why the other options are wrong
- A. Oral intubation is an advanced skill that requires a clear airway and good visualization; attempting it with a gurgling, obstructed airway before suctioning is inappropriate and dangerous.
- B. RSI is an advanced procedure that requires a patent, suctioned airway. Cricoid pressure is controversial and not a primary airway opening technique.
- C. A nasopharyngeal airway is contraindicated with severe facial trauma, especially suspected basilar skull fractures or fractured mandible, due to risk of intracranial insertion.
Traumatic Airway Management
Prioritizing airway patency and protection in trauma patients while considering potential cervical spine injury.
- Jaw-thrust is preferred over head-tilt/chin-lift.
- Suctioning is critical for secretions/blood/vomitus.
- Advanced airways may be needed, but basic maneuvers come first.
Memory trick: Gurgling, Grinding, Get it Gone!