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Primary survey in major trauma — MCCQE Part 1 MCQ

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HardTraumaPrimary survey in major traumaMCCQE Part 1

A motorcyclist with massive facial disruption has GCS 5. Two experienced attempts at orotracheal intubation fail; supraglottic airway placement also fails and oxygen saturation is 68% despite two-person bag-mask attempts. What is the next airway action?

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Correct answer: B — Create an emergency cricothyrotomy as the front-of-neck rescue airway

Repeat direct laryngoscopy using a hyperangulated video-laryngoscope blade: Repeating an unchanged failed technique delays oxygenation and increases bleeding and oedema. Obtain facial CT while maintaining the best achieved bag-mask oxygenation: Imaging is unsafe before oxygenation is restored. Perform formal tracheostomy after transfer to the operating theatre: Formal tracheostomy is slower and is not the usual immediate rescue procedure. Continue two-person bag-mask ventilation pending arrival of otolaryngology: Bag-mask ventilation has already failed, so waiting risks hypoxic arrest. Create an emergency cricothyrotomy as the front-of-neck rescue airway: Cricothyrotomy is the fastest definitive rescue airway in an adult trauma cannot-intubate-cannot-oxygenate scenario while cervical precautions continue.

Reference: https://emergencycarebc.ca/clinical_resource/clinical-summary/major-trauma/