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Question: Trauma

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You are caring for a 4 year old child struck by a car. The child has significant maxillofacial trauma, a large parietal hematoma, and a GCS score of 7. Attempts to intubate with direct and video laryngoscopy have been unsuccessful due to blood obscuring visualization of the airway, and you are only partially able to oxygenate and ventilate the child with bag-mask ventilation, with an O2 sat on 100% FiO2 of 80%.

What is your best next intervention?

pemsou5_wp • May 1, 2018

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  1. Kelly May 1, 2018 - 10:01 am Reply

    C. Needle cricothyrotomy. In a patient with significant maxillofacial trauma with blood in the airway, the laryngeal mask airway will not protect the airway from aspiration. A nasogastric tube should never be placed if there is the potential for cribiform plate disruption and tracking of the tube toward the brain. Needle, rather than surgical, cricothyrotomy is preferred in children < age 5-12 years (per PALS, 8 years). The airway should be secured before diagnostic interventions or going to the O.R.

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