Does he need to be intubated??

[InmyblooD]

An 18 year old male is transported to the ED after being involved in a rollover motor vehicle crash. The paramedics report that he is unresponsive, respirations are rapid and shallow, and his skin is cool to touch. The paramedics did not initiate treatment, other than spinal immobilization, since they were only 2 min. away from the hospital.

On assessment of the patient's airway, blood is noted in his mouth and oropharynx. Respirations are present.

What would you're interventions be??

[TinyRNgrl]

Never's a dangerous word in medicine.

You don't need radiography. You need a good understanding of trauma kinematics and what injury paterns typically produce basilar skull fractures. Like I said, with good assesment the risk is entirely managable.

So what do you do with the patient who has a closed head injury, is a poor candidate for prehospital intubation, is slightly obtunded but still has a gag reflex? Tie youself up at the head holding the patinet's airway open to the neglect of anything else? Or "risk" passing an NPA?

I have. I've also seen patients who's GCS was 7, were poor candidates for RSI but could have been managed with basic techniques become airway nightmares because someone followed the cookbook. There's a whole lot of incompetent providers out there. EMS, for all its bluster often does a poor job of teaching airway management and assesment. We're taught an ETT is the gold standard instead of whatever makes the chest go up and down and keeps blood, boogers and puke out of the lungs.

I am going to respect the fact that you are a competant provider and I am going to ask the same respect in return. I am good at what I do both in the ED and out in the field. So, if you choose to pass a NPA on your pt with a suspected or even obvious head injured person then that is your choice. But please don't critique everything I post because based off what I have been taught over the years that I would not opt for the nasal airway. And I do have a good understanding of "trauma kinetics" and I am well aware "never" is a dangerous word in medicine.

[ZippyGBR, BSN, RN]

YES!

IF he is truly unresponsive with shallow respirations.

the issues is

is that by the cookbook medic fire monkey with a half assed RSI protocol and limited assistance on scene or by an Anaesthetist or suitably skilled EM doc in the ED or at scene ...

[jujuseah, RN]

Intubation would be the first intervention. High chances of collasping.