DrPak
Forum Elite
Topics: 49
Posts: 348
|
A 35-year-old man is brought to the emergency department after being involved in a motorcycle accident, in which he was not wearing a helmet. On arrival he is tachypneic, but is conscious and able to talk with difficulty. His temperature is 37C(98.6F), blood pressure is 100/60 mm Hg, pulse is 110/min, and respirations are 35/min and noisy. Examination shows an obvious head injury and an open fracture of the femur. Which of the following 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
|
| Diego Casali
Forum Elite
Topics: 7
Posts: 234
|
Orotracheal intubation is the best way to manage the airway and breathing in this patient.
His ability to talk with difficulty and his noisy respirations speak for impending loss of the airway.
Furthermore, head trauma and the need for general anesthesia to repair the open fracture of the femur are two general indications for intubation in this case.
|
| mjl1717
Forum Hero
Topics: 955
Posts: 5,451
|
beautiful communication Casali! {something often taken for granted}:
And Dr Pak well thought out q , dont care where you got it! (its a reality)
___________________
Smell the coffee! "Is That an Osler move??"
|
| Aashi
Forum Moderator
Topics: 113
Posts: 1,028
|
A---------->Chin lift with Air mask
A trauma hx where the pt IS ABLE TO SPEAK-->means his AIRWAY IS SECURE, the noisy breathing( obstruction) will be cleared if the chin is lifted and with oxygen ---> decreases his respiratory rate, there by cutting down on his extra effort on breathing..
GL
___________________
"Obstacles are those frightful things you see when you take your EYES off your goal."
|
| robin082006
Forum Hero
Topics: 471
Posts: 5,125
|
A, this is UW q
___________________
The Key to Succeed is Patience.
|
| mjl1717
Forum Hero
Topics: 955
Posts: 5,451
|
good , got me on that,, Now I remember Fisher saying "head lift chin tilit."
___________________
Smell the coffee! "Is That an Osler move??"
|
| fighting_it_out
Forum Newbie
Topics: 2
Posts: 14
|
hi
but according to kaplan... here we donot know if this person also has a neck injury ...
so i would not go with chin lift .....
airway is okay , but grunting ...is impending airway obstruction .... i would go with "c"
it is not "b" because needle cric.... is not indicated whenever ther is a suspicion of a head injury .. because .. a needle will provide O2 but cannnot expire CO2 ... this will raise the ICP
|
| dr in trouble
Forum Guru
Topics: 60
Posts: 592
|
its A--usmle world q
___________________
If u want to do something, do it today as there is no tomorrow.
|
|
| |
| | | | | | | | |
