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Chapter 27. Airway Management for Penetrating Facial Trauma
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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
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A. keep the patient seated upright during awake look
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B. attempt blind nasal intubation
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C. assemble equipment for cricothyrotomy
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D. call for immediate assistance from a surgical colleague
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E. use of personal protective equipment
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(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.
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In the above scenario, when would a primary cricothyrotomy be appropriate?
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A. on initial presentation
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B. once the surgical colleague arrives
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C. after the initial attempt at awake look fails while oxygen saturation is 98%
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D. persistent oxygen desaturation
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E. with nasal hemorrhage that prevents blind nasal intubation
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(D) In the presence of persistent oxygen desaturation, cricothyrotomy would be an appropriate option.
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The incidence of associated unstable cervical spine fracture in a neurologically intact patient with penetrating facial trauma
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B. is not a concern provided a cervical collar that provides rigid immobilization is used
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C. ranges from 1% to 2.6% of patients
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D. in some studies approaches 20%
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E. has never been studied
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(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.