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GCS 7 Airway — RACP Adult Medicine MCQ

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EasyNeurologyGCS 7 AirwayRACP Adult Medicine

A 40-year-old man after a head injury has GCS 7 (E1V2M4). He has a gag reflex but cannot protect his airway. SpO₂ 94% with jaw thrust. CT shows a large extradural haematoma with midline shift. What is the most important immediate airway intervention?

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Correct answer: E — Endotracheal intubation (RSI)

GCS ≤8 (coma) mandates definitive airway management — endotracheal intubation via rapid sequence induction. This is a fundamental ATLS/ALS principle. GCS 7 = unable to protect airway reliably. RSI prevents aspiration and allows controlled ventilation. Concurrent management: neurosurgical evacuation of extradural haematoma (lucid interval may precede rapid deterioration), maintain CPP (MAP – ICP), and avoid secondary brain injury (hypotension, hypoxia, hypercarbia).

Reference: ATLS 10th Ed; eTG Emergency 2024