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

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

A. removal of the front of the cervical collar

B. oral intubation using direct laryngoscopy

C. cricoid pressure

D. external laryngeal manipulation

E. none of the above

(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.

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

A. performing an awake fiberoptic intubation

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

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

D. avoiding transient oxygen desaturation

E. all of the above

(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.

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

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

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

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

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

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

(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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