Airway maneuver to open airway recommended in trauma patient is?

NCL (MP) Nursing Officer - 2020

Medical & Surgical Nursing

Easy

Appeared in: NCL (MP) Nursing Officer - 2020

Explanation

The jaw-thrust maneuver is the gold standard for opening the airway in a patient with a known or suspected cervical spine injury.
This technique involves displacing the mandible (lower jaw) forward, which lifts the tongue off the posterior pharynx, thereby opening the airway.
Crucially, as illustrated in the image, it is performed without tilting or extending the head, which protects the cervical spine from further injury.
The American College of Surgeons' Advanced Trauma Life Support (ATLS) protocol mandates this approach for all trauma patients.

Option A: This maneuver involves extending the neck, which is contraindicated in trauma patients due to the high risk of worsening a potential cervical spine injury.
Option C: The Heimlich maneuver (abdominal thrusts) is designed to expel a foreign object from the airway of a conscious or unconscious choking victim. It is not a primary maneuver for opening the airway due to loss of muscle tone in an unresponsive patient.
Option D: This option is incorrect because it includes the Head tilt & Chin lift, which is contraindicated in trauma patients.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Airway management in trauma patients in acute care settings.
In emergency nursing, the rule is to always assume a cervical spine injury in any patient with multi-system trauma, especially with injury above the clavicles, until it is ruled out by imaging. This makes the jaw-thrust a critical, life-saving skill.
Failure to protect the cervical spine can lead to devastating neurological consequences, including permanent paralysis (quadriplegia) or death.
What if? If a trauma patient's airway cannot be opened with a jaw-thrust and basic adjuncts, it signifies a difficult airway. The nurse should immediately prepare for advanced airway management, such as endotracheal intubation by a trained provider, while maintaining C-spine stabilization.

How to Approach the Question

First, identify the key clinical context in the question: 'trauma patient'.
Recall the cardinal rule of trauma care: protect the cervical spine (C-spine). Any intervention must avoid moving the neck.
Evaluate each option against this rule.
Option A, 'Head tilt & Chin lift', involves tilting the head back. This violates the C-spine protection rule, so it is incorrect.
Option B, 'Jaw thrust', is specifically designed to open the airway without moving the neck. This aligns with the rule and is a strong candidate.
Option C, 'Heimlich', is for choking/foreign body obstruction, which is a different clinical problem. This is incorrect.

Concept Tested & Keywords

Concept Tested: Airway management in trauma patients
Stem keywords: Airway maneuver, trauma patient
Lead-in keywords: recommended
Clinical cues: The term 'trauma patient' is a critical cue to suspect a cervical spine injury and prioritize maneuvers that do not move the neck.

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