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Chapter 17. Airway Management of a Patient with Traumatic Brain Injury (TBI)

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Which of the following is contraindicated during intubation of the trauma patient undergoing C-spine precautions with manual in-line neck stabilization (MILNS)?

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A. removal of the front of the cervical collar

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B. oral intubation using direct laryngoscopy

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C. cricoid pressure

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D. external laryngeal manipulation

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E. none of the above

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(E) With an appropriate application of MILNS, there is no evidence to suggest that a clinically significant degree of cervical spinal movement is related to tracheal intubation using all the stated airway maneuvers, including the cricoid pressure and external laryngeal manipulation.

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Which of the following airway interventions has been shown to improve neurologic outcome in the headinjured patient with a potential cervical spine injury?

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A. performing an awake fiberoptic intubation

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B. performing manual in-line neck stabilization during intubation attempts

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C. use of an alternative to direct laryngoscopy, such as a GlideScope

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D. avoiding transient oxygen desaturation

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E. all of the above

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(D) The immediate priority in patient with TBI is oxygenation, due to evidence suggesting that even a single episode of hypoxemia can worsen the prognosis in the patient with TBI.

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Which of the following statements concerning the head injured patient is TRUE?

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A. Improved neurological outcome is associated with the avoidance of direct laryngoscopy for intubation in this population.

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B. The unconscious head-injured patient (GCS>8) has a threefold chance of cervical spine injury.

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C. Avoidance of cervical spine movement during airway management is more important than avoiding transient hypoxia and hypotension.

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D. The safest way of performing tracheal intubation is proven to be the flexible bronchoscope.

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E. The use of muscle relaxants for intubation of these patients is contraindicated because they will interfere with subsequent neurological evaluation.

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(B) Three recent studies suggest that the probability of associated C-spine injury is at least tripled in the head-injured patient with GCS scores of 8 or less.

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