Question

A 39-year-old man is admitted to the emergency department after an automobile collision. He is cyanotic, has insufficient respiratory effort, and has a GCS score of 6. His full beard makes it difficult to fit the oxygen facemask to his face. The most appropriate next step is to:

a. Perform endotracheal intubation without attempting bag-mask ventilation.

b. Attempt bag-mask ventilation using the best available mask seal.

c. Administer high-flow oxygen via a nasal cannula.

d. Administer naloxone intravenously.

Answer 1

The most appropriate step to manage the patient's airway in this emergency scenario is endotracheal intubation, as bag-mask ventilation might be ineffective and he requires immediate life-saving intervention.

Step-by-step explanation:

In this emergency medical scenario, the 39-year-old man presents with cyanosis and insufficient respiratory effort, indicating a critical obstruction in the airway or reduced oxygenation, and his low Glasgow Coma Scale (GCS) score of 6 suggests a significantly altered level of consciousness. Given the urgency, the inability to achieve a good seal with a facemask due to a full beard, and the immediate life-saving requirement, the most appropriate next step is to secure the airway with endotracheal intubation. Additionally, bag-mask ventilation may be challenging with an ineffective seal due to facial hair, and nasal cannula may not provide adequate oxygenation given his condition. Naloxone is indicated in cases of suspected opioid overdose, which is not supported by information provided in the scenario.