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Penetrating Neck Trauma Airway — FRCA Final MCQ

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HardTrauma & Emergency AnaesthesiaPenetrating Neck Trauma AirwayFRCA Final

A 28-year-old man has a penetrating zone II neck injury with an enlarging haematoma and inspiratory stridor. He remains conscious, cooperative and able to maintain a sitting position; his SpO2 is 97% with supplemental oxygen. There is no haemoptysis, blood in the mouth, bubbling from the wound or surgical emphysema. In theatre, gentle awake flexible nasendoscopy after topical anaesthesia shows a narrowed but patent supraglottic airway, a clearly visible glottis and no apparent laryngeal disruption. A senior airway anaesthetist is present and an ENT surgeon is scrubbed for immediate front-of-neck airway access. What is the most appropriate initial method of securing the airway?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Awake oral flexible bronchoscopic tracheal intubation

Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E

B is correct. The airway is threatened but remains patent, the patient is cooperative and oxygenating, and nasendoscopy shows a visible glottis without airway contamination or apparent laryngeal disruption. Awake flexible bronchoscopic intubation therefore permits continuous visualisation while preserving spontaneous ventilation and airway tone. Sedation should be absent or minimal, with oxygenation, suction and an immediately executable surgical plan. Induction and neuromuscular blockade before securing this compressed airway (A or E) could convert partial obstruction into complete obstruction and make ventilation impossible. Awake tracheostomy (C) is appropriate when severe obstruction, laryngotracheal disruption, contamination or an impassable upper airway makes awake intubation unsafe, but those features have been excluded. Needle cricothyroidotomy (D) is a temporary rescue oxygenation technique, not the preferred primary definitive airway in an oxygenating patient.

Reference: Royal College of Anaesthetists and Difficult Airway Society. NAP4: Major complications of airway management in the United Kingdom, Chapters 14 and 18, 2011. https://www.rcoa.ac.uk/sites/default/files/documents/2019-09/NAP4%20Full%20Report.pdf