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  #1  
Old 07-19-2012
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ER Best Airway in Neck Trauma!

A 25-year-old man is brought to the emergency department after falling 12m (40ft) from a ladder. He is unconscious. Examination shows obvious head and neck injuries, and a fractured forearm. He is totally
apneic. Which of the following would be the best method to establish an immediate definitive airway in this patient?

A. Nasotracheal intubation
B. Orotracheal intubation
C. Needle cricothyroidectomy
D. Intubation over a fiberoptic bronchoscope
E. Surgical tracheostomy

please give reason along
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  #2  
Old 07-19-2012
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B. Orotracheal intubation

head and neck trauma. so orotracheal preferred - to avoid neck manipulation.


C. Needle cricothyroidectomy -- preferred in the field.. but since the patient is in the ER -- intubation is better

D. Intubation over a fiberoptic bronchoscope-- can be tried but not first line. -- and this is usually nasotracheal.

E. Surgical tracheostomy -- performed in case of head, neck AND FACE trauma (cos then orotracheal intubation is risky)

Last edited by mbbs2010; 07-19-2012 at 02:43 PM.
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Old 07-19-2012
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ans .D......... head and neck injury plus apneic .......
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Old 07-19-2012
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Quote:
Originally Posted by Hitman View Post
ans .D......... head and neck injury plus apneic .......
yup. ur right.
my bad.

god these questions are always confusing!
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Quote:
Originally Posted by mbbs2010 View Post
yup. ur right.
my bad.

god these questions are always confusing!
i had just guessed from reading stifedl post , have no clue about Sx ..

it would be great if you could tell me which procedure to use when ???
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Old 07-19-2012
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Ans is pro pharyngeal airway !!!
And source is UWORLD.


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Old 07-19-2012
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In managing the patient with trauma, first priority should be to establish an airway followed by securing breathing and circulation (ABC of resuscitation). In a totally apneic patient like this, an appropriate airway should be restored as soon as possible.

Orotracheal intubation is the best way to restore airway in this patient. A facemask is not a mean to establish an airway. An orotracheal intubation needs hyperextension of neck and should be done only after a cervical spine injury is ruled out or in case of apneic patient. Though this patient is apneic and is also at risk of having a cervical injury the benefits of orotracheal intubation outweighs the risk and so an orotracheal intubation should be done with care not to move the head (Choice B). Another option would be to do a surgical cricothyroidectomy.

Choice A: Nasotracheal intubation is a blind procedure and it is necessary that patient should have a spontaneous breathing. Thus it is contraindicated in apneic patients.

Choice C: Needle cricothyroidectomy is an excellent field procedure to establish an airway especially in children. However, it is not suitable in adults due to risk of carbon dioxide retention especially in patients with head injury where hyperventilation can be required to prevent or treat intracranial hypertension.

Choice D: Intubation over a fiberoptic bronchoscope although very effective cannot be performed so rapidly to meet the needs of an apneic patient.

Choice E: Tracheostomy is no longer a first option to establish an airway because of its complications. A surgical cricothyroidectomy is always preferred over surgical tracheostomy, however a cricothyroidectomy should be converted to formal tracheostomy in 5-7 days if prolonged airway control is needed as cricothyroidectomy has high incidence of tracheal stenosis with prolonged use.
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Old 07-19-2012
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moral of the story. dont second guess urself!



thanks tyagee and novobiocin
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Quote:
Originally Posted by mbbs2010 View Post
moral of the story. dont second guess urself!
Exactly.

Also remember, surgical cricothyroidectomy is contraindicated in children.
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Old 07-20-2012
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Is this info ok?

Orotracheal intubation CI in neck injury.

Nasotracheal intubation CI in facial injury.

Surgical tracheostomy Always CI in emergency intubation.

But still in apneic patient with head and neck injury ans is orotracheal intubation !!!


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Orotracheal intubation CI in neck injury.

only as long as the neck is not stabilized.
once the neck is stabilized it is the fastest way to intubate!
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Quote:
Originally Posted by tyagee View Post
But still in apneic patient with head and neck injury ans is orotracheal intubation !!!
The key phrase here is it should be "done with care not to move the head".
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