Indication for Intubation in Trauma — FRCA Final MCQ

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EasyTrauma & Emergency AnaesthesiaIndication for Intubation in TraumaFRCA Final

A 28-year-old man with a suspected head injury following a head-on road traffic collision has been initially resuscitated. His Glasgow Coma Scale score is 7 (E1V2M4): he does not open his eyes, speak or obey commands. Which finding is the specific NICE indication for immediate tracheal intubation and ventilation in this patient?

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Correct answer: B — Coma with a GCS score of 8 or less

The correct answer is B. NICE NG232 identifies coma—defined as not obeying commands, not speaking and not eye opening, corresponding to a GCS score of 8 or less—as an indication for immediate intubation and ventilation. This patient has GCS 7 (E1V2M4) and meets that definition. NICE NG39 more generally recommends drug-assisted RSI and intubation when a major-trauma patient cannot maintain their airway and/or ventilation. An open femoral fracture requires haemorrhage control, analgesia and definitive orthopaedic care but is not itself an airway indication. A high-energy mechanism and the need for CT may influence assessment and logistics but do not independently mandate intubation. Hypotension requires urgent identification and treatment of haemorrhage; in isolation, with adequate airway and ventilation, it is not an indication for tracheal intubation.

Reference: NICE. Head injury: assessment and early management (NG232), recommendations 1.4.6 and 1.8.8. 2023. https://www.nice.org.uk/guidance/NG232/chapter/recommendations