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Chapter 19. Airway Management of a Race Car Driver with a Full-Face Helmet Following a Crash

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You are about to perform a tracheal intubation in an unconscious, 29-year-old male motorcycle driver who was involved in a high-speed MVC. His open-face helmet is in place. His airway examination is favorable, and he has no predictors of difficult bag-mask-ventilation, EGD insertion, or laryngoscopy. Regarding his helmet, which of the following statements is true?

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A. A skilled assistant should maintain inline stabilization of the patient's head and neck during the airway intervention.

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B. If the open-face style helmet is not obstructing the line-of-sight for laryngoscopy, it may remain in place during the airway intervention.

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C. A rapid-sequence induction (RSI) technique with a muscle relaxant is a reasonable choice to facilitate endotracheal intubation.

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D. All of the above are true.

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(D) In a patient wearing an open-face helmet, airway management can be performed with the helmet in place and the patient's head can be manually stabilized by an assistant to minimize movement of the head and neck. Direct laryngoscopic intubation under RSI is an acceptable technique to secure the airway.

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A 20-year-old motorcycle driver is involved in a highspeed MVC. He is brought to your hospital on a spine board still wearing his full-face style helmet. His vital signs are stable and he is cooperative. He complains of pain in his left leg and his neck. You should:

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A. Remove his helmet immediately and provide supplemental oxygen.

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B. Carefully remove the helmet by yourself and ask the patient to inform you of any discomfort.

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C. Ask the patient to carefully remove the helmet himself while you assist him.

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D. Complete your primary survey assessment, provide oxygen through his helmet if necessary, and complete lateral C-spine x-rays with the helmet in place prior to removing the helmet with the assistance of a skilled colleague.

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(D) In a stable, cooperative patient involved in a high-speed MVC, who is brought to the hospital on a spine board still wearing his full-face style helmet, the most appropriate management is to complete the primary survey assessment, provide oxygen through his helmet if necessary, and complete lateral C-spine x-rays with the helmet in place prior to removing the helmet with the assistance of a skilled colleague.

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You assess a 50-year-old male motorcyclist who was involved in a high–speed MVC. He is wearing a modular full–face helmet with the face shield retracted. He is unconscious, breathing ...

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