The nurse witnesses a neighbour's husband sustain a fall from the roof of his house. The nurse rushes to the victim and determines the need to open the airway. The nurse opens the airway in this victim with the use of which method?

1. A

   Flexed position

2. B

   Head tilt-chin lift maneuver

3. C

   Jaw thrust maneuver

4. D

   Modified head tilt-chin lift maneuver

Appeared in: NORCET 3 - 2022 (Shift-1)

Explanation

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• A fall from a height creates a high suspicion of a cervical spine (neck) injury.
• In trauma care, the primary goal is to open the airway while protecting the spine from any movement to prevent further damage.
• The jaw-thrust maneuver is the correct technique because it moves the jaw (mandible) forward to lift the tongue off the back of the throat, without tilting the head or extending the neck.
• This procedure is the standard of care for opening the airway in unconscious patients with a suspected spinal injury.

Why Other Options Were Wrong

• Option A: A flexed position would cause the neck to bend forward, which can obstruct the airway by causing the tongue to block the pharynx and is dangerous in a potential spinal injury.
• Option B: This maneuver involves tilting the head backward and lifting the chin. This hyperextension of the neck is contraindicated in patients with a suspected cervical spine injury as it can cause or worsen damage to the spinal cord.
• Option D: While the term 'modified' might imply safety, the standard and recommended technique for trauma is the jaw-thrust maneuver. Any technique involving a 'head tilt' is considered a secondary, riskier option if the jaw-thrust fails.

Related Visual

Clinical Relevance

• Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Airway management in trauma with suspected cervical spine injury in acute care settings.
• The cardinal rule in trauma is to assume a cervical spine injury in any patient with a significant mechanism of injury (e.g., fall from height, motor vehicle accident, diving accident) until it is medically cleared.
• As a first responder, a nurse's correct initial actions can prevent iatrogenic (caregiver-caused) injury, such as paralysis from improper handling of the neck.
• What if? If the person was found unconscious with no signs of trauma (e.g., a suspected heart attack), the head tilt-chin lift maneuver would be the correct initial method to open the airway.

How to Approach the Question

• First, analyze the mechanism of injury presented in the question. A 'fall from the roof' is a high-energy trauma.
• Recognize the most immediate, life-threatening risk associated with this type of trauma, which is a cervical spine injury.
• Recall the fundamental principle of trauma care: protect the spine. This means avoiding any movement of the head and neck.
• Apply this principle to the task at hand: opening the airway.
• Evaluate the given options to determine which one accomplishes the task without moving the neck.
• Select the jaw-thrust maneuver, as it is specifically designed for this purpose, unlike the head tilt-chin lift which is contraindicated.

Concept Tested & Keywords

• Concept Tested: Airway management in trauma with suspected cervical spine injury.
• Stem keywords: fall from the roof, open the airway, victim
• Lead-in keywords: which method
• Clinical cues: "fall from the roof of his house" indicates a high-impact trauma, raising suspicion for a cervical spine injury.
• Negative lead-in flag: false

Question ID

QrsMCrKCFgeTuwuZPezK4o

Copy ID

Reference Book

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