Airway and ventilary management
A 6-month-old infant, being held in her mother's arms, is ejected on impact from a
vehicle that is struck head-on by an oncoming car traveling at 64 kph (40 mph). The
infant arrives in the emergency department with multiple facial injuries, is lethargic,
and is in severe respiratory distress. Respiratory support is not effective using a bag-
mask device, and her oxygen saturation is falling. Repeated attempts at orotracheal
intubation are unsuccessful. The most appropriate procedure to perform next is:
Kies het juiste antwoord:
a. perform emergency tracheotomy
b. perform nasotracheal intubation
c. repeat orotracheal intubation (by a very experienced anesthetist)
d. add 1% CO2 to the inspired air
e. puncture the cricothyroid membrane with a needle and attempt jet insufflation
Antwoord E
An 18-year-old motorcyclist sustains severe facial injuries in a head-on crash with a
pick-up truck. He is brought to the emergency department with his cervical spine
immobilized by head blocks. His blood pressure is 150/88 mm Hg, heart rate is 88
beats per minute and regular, and respiratory rate is 26 breaths per minute. His
respirations are labored and sonorous. His Glasgow Coma Scale score is 7.
Attempts at orotracheal intubation with manual inline stabilization of the c-spine are
unsuccessful due to bleeding and distorted anatomy. The patient becomes apneic.
The best procedure for airway management in this situation is:
Kies het juiste antwoord:
a. insertion of a laryngeal mask airway
b. another attempt at endotracheal intubation using the gum elastic bougie
c. ventilation by balloon-valve-mask
d. jet insufflation via needle cricothyroidotomy
e. providing the patient with surgical airway
Antwoord E
A middle-aged male sustains multiple injuries in a single car crash and is taken to a
level 1 hospital. He is hemodynamically normal, but has obvious, multiple facial
lacerations and fractures. His breath sounds are slightly decreased over the right
hemithorax, but he is not in respiratory distress. His abdomen is soft and active
bowel sounds are auscultated. His Glasgow Coma Scale score is 7. A chest x-ray
demonstrates a widened mediastinum. Initial management should be:
Kies het juiste antwoord:
a. insertion of intravenous canulae
b. endotracheal intubation
c. tube thoracostomy
d. needle thoracostomy
A 6-month-old infant, being held in her mother's arms, is ejected on impact from a
vehicle that is struck head-on by an oncoming car traveling at 64 kph (40 mph). The
infant arrives in the emergency department with multiple facial injuries, is lethargic,
and is in severe respiratory distress. Respiratory support is not effective using a bag-
mask device, and her oxygen saturation is falling. Repeated attempts at orotracheal
intubation are unsuccessful. The most appropriate procedure to perform next is:
Kies het juiste antwoord:
a. perform emergency tracheotomy
b. perform nasotracheal intubation
c. repeat orotracheal intubation (by a very experienced anesthetist)
d. add 1% CO2 to the inspired air
e. puncture the cricothyroid membrane with a needle and attempt jet insufflation
Antwoord E
An 18-year-old motorcyclist sustains severe facial injuries in a head-on crash with a
pick-up truck. He is brought to the emergency department with his cervical spine
immobilized by head blocks. His blood pressure is 150/88 mm Hg, heart rate is 88
beats per minute and regular, and respiratory rate is 26 breaths per minute. His
respirations are labored and sonorous. His Glasgow Coma Scale score is 7.
Attempts at orotracheal intubation with manual inline stabilization of the c-spine are
unsuccessful due to bleeding and distorted anatomy. The patient becomes apneic.
The best procedure for airway management in this situation is:
Kies het juiste antwoord:
a. insertion of a laryngeal mask airway
b. another attempt at endotracheal intubation using the gum elastic bougie
c. ventilation by balloon-valve-mask
d. jet insufflation via needle cricothyroidotomy
e. providing the patient with surgical airway
Antwoord E
A middle-aged male sustains multiple injuries in a single car crash and is taken to a
level 1 hospital. He is hemodynamically normal, but has obvious, multiple facial
lacerations and fractures. His breath sounds are slightly decreased over the right
hemithorax, but he is not in respiratory distress. His abdomen is soft and active
bowel sounds are auscultated. His Glasgow Coma Scale score is 7. A chest x-ray
demonstrates a widened mediastinum. Initial management should be:
Kies het juiste antwoord:
a. insertion of intravenous canulae
b. endotracheal intubation
c. tube thoracostomy
d. needle thoracostomy
