Question

"You are on scene at a motor vehicle accident, and your 20-year-old patient is entrapped. He is unconscious, unresponsive, and has a palpable carotid pulse that is weak and thready. His breathing is slow and shallow at four times a minute with equal chest wall expansion. There are no obvious deformity injuries or hemorrhage noted. Fire department on-scene has stabilized the vehicle and provided you and your partner a relatively safe environment to manage the entrapped patient. However, access is limited to the seated patient, and extrication is expected to take another twenty minutes.

After having your partner maintain cervical spine stabilization, which of the following would be the best choice for securing the patient's airway?

A. Insert a nasal airway and administer high-flow oxygen therapy

B. Use nasotracheal intubation techniques to gain complete control of the patient's airway and assist ventilation

C. Intubate the patient using the blind orotracheal intubation technique to maintain in-line mobilization of the spine, then assist ventilation

D. Insert a King LTD and begin assisting ventilations with a bag-valve mask"

Answer 1

For an entrapped, unconscious patient, nasotracheal intubation is the best method for airway management, allowing for assisted ventilation while maintaining cervical spine stabilization. Therefore the correct option is B: Use nasotracheal intubation techniques to gain complete control of the patient's airway and assist in ventilation.

Step-by-step explanation:

In the case of the 20-year-old patient who is unconscious, unresponsive, and has a compromised airway due to an accident, it is crucial to secure the airway promptly while awaiting extrication. Given the patient's condition and limited access, the best choice for securing the patient's airway would be Option B: Use nasotracheal intubation techniques to gain complete control of the patient's airway and assist ventilation. This method allows for airway management without moving the head or neck, thus preserving cervical spine stabilization. Performing a nasotracheal intubation provides a definitive airway and allows the healthcare provider to assist with ventilation, ensuring the patient receives adequate oxygen.