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Chapter 18. Airway Management of an Unconscious Patient Who Is Trapped Inside the Vehicle Following a Motor Vehicle Collision

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You are called to a motor vehicle collision, where the driver is trapped inside the car. The patient is unconscious and making ineffective respiratory efforts. How do you manage this patient?

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A. Extricate the patient as soon as possible.

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B. Insert a nasal airway to relief airway obstruction.

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C. Intubate the patient using a rapid sequence induction to avoid aspiration.

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D. Following basic airway maneuvers to relief obstruction you attempt bag-mask-ventilation.

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E. Since you are facing an impending loss of airway, you attempt a surgical cricothyrotomy.

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(D) Following the advanced trauma life support guidelines, basic airway maneuvers followed by bag-mask-ventilation is the first choice.

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Which of the following statements is INCORRECT?

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A. The risk of aspiration during ventilation with an EGD is low.

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B. EGDs are effective alternatives should endotracheal intubation fail.

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C. EGDs can be placed easily facing the patient from the front.

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D. EGDs can be used successfully with a steep learning curve in practitioners unfamiliar with advanced airway techniques.

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E. All EGDs are equally effective in the trauma population.

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(E) EGDs are effective alternatives in the management of trauma patients but not all are equally effective. Further development of newer devices and research studies will present ongoing data on the best currently available device.

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Which of the following may make airway management difficult in the trapped patient?

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A. No access from above.

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B. Intraoral blood from head and neck injury.

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C. Suspected cervical spine injury.

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D. Acuity of the scene.

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E. All of the above.

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(E) Airway management of a trapped patient following a motor vehicle crash presents a challenge even for the experienced pre-hospital practitioner due to the time pressure and scene safety.

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