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Chapter 27. Airway Management for Penetrating Facial Trauma

The patient above presents in tripod position to maintain adequate breathing. Blow-by oxygen is provided by mask. Appropriate strategies to initially secure the airway would NOT include

A. keep the patient seated upright during awake look

B. attempt blind nasal intubation

C. assemble equipment for cricothyrotomy

D. call for immediate assistance from a surgical colleague

E. use of personal protective equipment

(B) In general, in the presence of an altered airway anatomy (e.g., facial trauma), the use of a “blind” airway technique would be inappropriate.

In the above scenario, when would a primary cricothyrotomy be appropriate?

A. on initial presentation

B. once the surgical colleague arrives

C. after the initial attempt at awake look fails while oxygen saturation is 98%

D. persistent oxygen desaturation

E. with nasal hemorrhage that prevents blind nasal intubation

(D) In the presence of persistent oxygen desaturation, cricothyrotomy would be an appropriate option.

The incidence of associated unstable cervical spine fracture in a neurologically intact patient with penetrating facial trauma

A. is negligible

B. is not a concern provided a cervical collar that provides rigid immobilization is used

C. ranges from 1% to 2.6% of patients

D. in some studies approaches 20%

E. has never been studied

(A) To date, there have been no cases reported of isolated penetrating injury to the face that have resulted in an unstable cervical spine fracture in an awake, alert, neurologically intact patient.

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