Question 5 of 34

A 22-year-old man is brought by ambulance from the scene of a major motor vehicle crash. He is initially awake and alert, but somewhat combative. His prehospital hypotension and tachycardia have responded to 2 L of intravenous crystalloid. A cervical spine series is normal. Suddenly he vomits and loses consciousness. Your attempts to clear the airway are hampered by a malfunctioning suction apparatus and his pulse oximetry readings begin to plummet. Of the choices listed, your next move should be:

Transtracheal ventilation.

Paralysis by pancuronium, bag-mask ventilation, obtain new suction device.

Paralysis by succinylcholine and placement of a nasogastric tube.

Emergent tracheostomy.

Nasotracheal intubation.

This patient has a multifactorial etiology for his altered level of consciousness: hypoxemia, alcohol, hypovolemia, and head injury. Transtracheal ventilation is a useful temporizing measure to provide oxygen until the upper airway is cleared. Muscle paralysis is frequently necessary in agitated patients to allow intubation. Succinylcholine has a faster onset of action and a shorter duration of action than that of pancuronium. Cricothyroidotomy is an alternative method for the difficult airway. Emergency tracheostomy is rarely required.