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Pre-hospital RSI — DIPIMC MCQ

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HardPre-Hospital TraumaPre-hospital RSIDIPIMCDipIMC

A 35-year-old assaulted with a baseball bat has a major head injury. He has a GCS of 7, is combative, has vomited once and has oxygen saturations of 89% despite a non-rebreathe mask. An enhanced-care team with anaesthetic capability is on scene. What is the most appropriate airway management?

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Correct answer: A — Pre-hospital rapid sequence induction and intubation

A combative patient with a GCS of 7, vomiting and hypoxia despite oxygen has an unprotected, failing airway, and pre-hospital rapid sequence induction with intubation by a competent team provides definitive protection and allows controlled oxygenation and ventilation. Basic adjuncts and a supraglottic airway do not protect against aspiration in this setting, and leaving him to self-manage is unsafe. Pearl: indications for pre-hospital RSI include failure to maintain or protect the airway, inadequate oxygenation or ventilation, and the anticipated clinical course.

Reference: JRCALC Clinical Guidelines; Faculty of Pre-Hospital Care (RCSEd)