An unconscious patient is breathing noisily. You suspect that his airway is collapsed. Which of the following actions is NOT RECOMMENDED?

1. A

   Head tilt chin lift

2. B

   Jaw thrust

3. C

   Using a Godel's airway

4. D

   Give oxygen by face mask

Appeared in: RML Lucknow - 2021

Explanation

• The fundamental principle in emergency resuscitation is Airway, Breathing, Circulation (ABC).
• Noisy breathing (e.g., snoring, gurgling) in an unconscious patient signifies a partially obstructed airway, which must be addressed first.
• Administering oxygen via a face mask is an intervention for 'Breathing'. It is ineffective and a waste of critical time if the 'Airway' is blocked, as oxygen cannot reach the lungs.
• The correct sequence is to first establish a patent airway, and only then provide oxygen or assist ventilation.

Why Other Options Were Wrong

• Option A: This is a recommended primary maneuver to open the airway.
• Option B: This is a recommended primary maneuver to open the airway, specifically in trauma cases.
• Option C: This is a recommended airway adjunct to maintain an open airway.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Airway management in an unconscious patient in acute care settings.
• The 'Airway first' principle is the most critical concept in all resuscitation scenarios. A compromised airway leads to hypoxia and irreversible brain damage within 3-5 minutes.
• Nurses must be able to rapidly assess for signs of airway obstruction (e.g., snoring, gurgling, stridor, use of accessory muscles) and intervene immediately.
• What if? If the patient had a gag reflex, inserting a Guedel's (oropharyngeal) airway would be contraindicated as it could stimulate vomiting and lead to aspiration. In such a case, a nasopharyngeal airway (NPA) might be considered.

How to Approach the Question

• First, identify the question type. This is a negative question ('NOT RECOMMENDED') that tests your knowledge of clinical priorities.
• Recall the fundamental principle of emergency care: A-B-C (Airway, Breathing, Circulation). This hierarchy dictates the order of interventions.
• Analyze the patient's condition. 'Unconscious' and 'breathing noisily' are classic signs of an 'A' (Airway) problem.
• Evaluate each option against the A-B-C hierarchy. Options A, B, and C are all interventions designed to establish or maintain the 'Airway'.
• Option D is an intervention for 'Breathing'.
• Applying a 'Breathing' intervention before resolving the 'Airway' problem violates the A-B-C sequence and is therefore the incorrect action.

Concept Tested & Keywords

• Concept Tested: Airway management in an unconscious patient
• Stem keywords: unconscious patient, breathing noisily, collapsed airway
• Lead-in keywords: NOT RECOMMENDED
• Clinical cues: Noisy breathing in an unconscious patient is a classic sign of airway obstruction.
• Negative lead-in flag: Action NOT RECOMMENDED

Question ID

Q_VpXpeWUNV2DTogk14Shh

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 3 p. 115-117

E6 Nelson Textbook of Pediatrics(2024) — Volume 1 p. 616-618