SAQ 387 – Airway – anterior neck trauma with possible airway injury

Review Completed

Marked out of 18.00

You are the consultant in a regional emergency department without anaesthetics or ENT surgical services. A 24-year-old man presents 10 minutes after riding his motorcycle into a plain wire fence. He has throat pain and a linear bruise across the anterior neck. The nearest ENT service is 30 minutes away by road.

List four (4) signs, other than bruising, that suggest airway injury.

(Marked out of 4.0)

/ 4

Give two (2) advantages and two (2) disadvantages of intubating him before transfer.

(Marked out of 4.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th></th> <th>Points</th> </tr> </thead> <tbody> <tr> <td>Advantages</td> <td></td> </tr> <tr> <td>Disadvantages</td> <td></td> </tr> </tbody> </table> <p>

/ 4

If you proceed to intubation, give three (3) ways this intubation differs from a standard RSI and explain why.

(Marked out of 6.0)
</p> <table class="saq-prop-table"> <thead> <tr> <th>Variation from standard RSI</th> <th>Reason</th> </tr> </thead> <tbody> <tr> <td>1.</td> <td></td> </tr> <tr> <td>2.</td> <td></td> </tr> <tr> <td>3.</td> <td></td> </tr> </tbody> </table> <p>

/ 6

Besides the airway, list other vital structures that may be injured by this mechanism.

(Marked out of 4.0)

/ 4

Total Score: 0 / 18

Percentage: 0%

Advantages	Disadvantages
Provides a definitive airway for transfer and avoids needing airway intervention en route.	Intubation is high risk without anaesthetics or ENT backup, including failed intubation or cannot-intubate-cannot-oxygenate.
Transfer urgency may be reduced, and early intubation may succeed before airway oedema worsens.	Instrumentation may worsen the airway injury, for example converting partial transection into complete transection.
Cervical-spine precautions can be applied more reliably once the airway is secured.

Variation	Reason
Maintain spontaneous ventilation and avoid paralysis where possible.	Paralysis may precipitate complete airway obstruction. This concept is essential.
Keep the patient sitting up or in the position they tolerate.	Optimises airway patency and supports spontaneous ventilation.
Use a smaller endotracheal tube.	Airway oedema is likely and a large tube may worsen injury.
Mark the surgical-airway site and have a second team prepared for surgical airway.	High risk of failed supraglottic rescue and CICO.
Use in-line cervical-spine immobilisation.	Trauma mechanism carries cervical-spine injury risk.

← Previous SAQ Next SAQ →