Mr. Pawan was brought to the casualty following an accidental fall from a tree. He was transferred on a trolley. Suddenly the nurse noticed cessation of breathing and unresponsiveness. The preferred technique to open his airway is?

1. A

   Head tilt-Chin lift manoeuvre

2. B

   Jaw thrust manoeuvre

3. C

   Abdominal Thrust manoeuvre

4. D

   AMBU ventilation

Appeared in: SCTIMST Staff Nurse - 2015 (Set-B)

Explanation

• The Jaw thrust manoeuvre is the recommended method for opening the airway in patients with a suspected cervical spine injury.
• This technique moves the jaw forward to lift the tongue off the pharynx without extending or flexing the neck, thus protecting the spinal cord.
• The mechanism of injury (fall from a tree) makes protecting the cervical spine a top priority.
• It is a critical skill in the primary survey (Airway) of the Advanced Trauma Life Support (ATLS) protocol.

Why Other Options Were Wrong

• Option A: The Head tilt-Chin lift manoeuvre involves extending the neck, which is dangerous and contraindicated in a patient with a suspected cervical spine injury as it can cause further damage.
• Option C: The Abdominal Thrust (Heimlich) manoeuvre is used to dislodge a foreign body that is causing an airway obstruction. It is not a technique for opening the airway in an unresponsive, non-choking patient.
• Option D: AMBU (bag-valve-mask) ventilation is a method for providing breaths (breathing support), not for opening the airway. The airway must be opened first before AMBU ventilation can be effective.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Airway management in trauma in acute care settings.
• In any trauma situation, always assume a cervical spine injury until it is cleared by a medical professional. This 'assume the worst' approach prevents iatrogenic (caregiver-caused) injury.
• The sequence of care is critical: first, open the airway (A), then ensure breathing (B). Applying a breathing device like an AMBU bag to a closed airway is ineffective and wastes critical time.
• What if? If the patient had fainted from a standing position with no trauma, the Head tilt-Chin lift would be the correct initial manoeuvre, as the suspicion for spinal injury would be very low.

How to Approach the Question

• First, analyze the clinical scenario. The key information is 'accidental fall from a tree', which immediately signals a high-risk trauma situation.
• Identify the core problem: the patient is unresponsive and not breathing, requiring immediate airway management.
• Connect the mechanism of injury (fall) to the primary contraindication: potential cervical spine injury. Any manoeuvre that moves the neck is dangerous.
• Evaluate the options based on this constraint. Eliminate 'Head tilt-Chin lift' because it moves the neck.
• Differentiate the purpose of the remaining options. 'Abdominal Thrust' is for choking. 'AMBU ventilation' is for breathing, not opening the airway.
• Conclude that 'Jaw thrust manoeuvre' is the only option that safely opens the airway in a patient with a suspected spinal injury.

Concept Tested & Keywords

• Concept Tested: Airway management in trauma
• Stem keywords: accidental fall, cessation of breathing, unresponsiveness, open airway
• Lead-in keywords: preferred technique
• Clinical cues: Fall from a tree suggests a high risk of cervical spine injury.

Question ID

Qa0TAvynpjgtmXKG9RuFoc

Copy ID

Reference Book

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

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 764-766

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