robin082006
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A 35-year-old Caucasian male is involved in a motorcycle accident, in which he was not wearing a helmet. Upon arrival to the ER he is tachypneic, but is conscious and able to talk with difficulty. He has an obvious head injury and an open fracture of femur. His vitals are, Temperature: 37C(98.6F); PR: 110/min; BP: 100/60mm Hg; RR: 35/min, and noisy. What would be the best way to manage the airway and breathing in this patient?
A. Chin lift with facemask.
B. Needle cricothyroidectomy.
C. Surgical cricothyroidectomy
D. Naso tracheal intubation
E. Orotracheal intubation.
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| sarika
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but is conscious and able to talk with difficulty.
i will choose A chin lift face mask
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| CocaCola
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conscious but noisy breathing and no hemlet (facial fractures), and head injury (possible neck injury)...
this patient may have an unstable airway and needs to intubated...
I choose C - surgical cricothyroidectomy
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| Guptashutosh
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y do u need to remove his cricoid and thyroid cocacola...
yes he needs an immediate intubation that can be done either nasotracheal sounds better option in case he had neck injury
i`ll go with D
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| Guptashutosh
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but one thing i `d like to utter here is , he was not wearing helmet , and the neck injuries r more common with the one who dashed wearing a helmet , also there is no such word sugggestive of neck injury , so orotracheal intubation can also be a good option becoz nasotracheal intubation may require more expertise guys like an ent surgeon , also bronchoscope...orotracheal can be done with comparativerly less expertise........ so unless and until have any contraindications mentioned i`ll go with OROTRACHEAL INTUBATION
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| sarika
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first thing to assess airway is to see weather the person is conscious or not talking or not. if they are the airway is fine. suppose they want to suggest airway will be lost soon, they say breathing present but gurggly stridor etc...or and expanding emphysema...none of which is here...
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| robin082006
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Sarika is right,
answer is A
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| CocaCola
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A cricothyroidectomy is not removal of his cricoid or thyroid... it is a small incision at the level of the larynx into the cricoid and thyroid cartilage to provide an alternate airway...
Sarika does have a point - the question doesn't report that the patient has gurgly speech or stridor... however it does suggest that there may be facial fractures ( lack of helmet, difficulty talking, and head injuries)
i still believe the question also suggest neck injury - I stand by cricothyroidectomy!!!
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| Guptashutosh
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wel i beg yr pardon dear what u were tlking about is CRICOTHYROIDOTOMY , And not cricothyroi-DECTOMY there is a diff. ,
sarika may be right but what i want to say is there is no such signs mentioned here for facial or cervical injury , if there was any they shd have mentioned here in Q...
he is tachypneic rr 35 able to talk with diff, he may have persistent airway but he is at risk for aspiration for which he needs to be intubated...
and the Q asked is wat is the BEST way to manage the airway and breathng ?
robin is it an nbme Q , where did u get the ans of this Q ?
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| lecheah
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hey robin,
the question meantioned noisy breathing,
does that not mean patient need an airway too???
i think it's E
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| robin082006
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this is UW's
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| CocaCola
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OK Guptas - I stand corrected... bottom line I wasn't thinking...
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