Neurological Disorders Q 74 - Gyan Darpan : Learning Portal
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Monday 18 April 2022

Neurological Disorders Q 74

A 20-year-old client who fell approximately 30’ is unresponsive and breathless. A cervical spine injury is suspected. How should the first-responder open the client’s airway for rescue breathing?
     A. By inserting a nasopharyngeal airway.
     B. By inserting an oropharyngeal airway.
     C. By performing a jaw thrust maneuver.
     D. By performing the head-tilt, chin-lift maneuver.

Correct Answer: C. By performing a jaw thrust maneuver.

If the client has a suspected cervical spine injury, a jaw-thrust maneuver should be used to open the airway. Maintain patent airway: keep head in neutral position, elevate head of bed slightly if tolerated, use airway adjuncts as indicated. Patients with high cervical injury and impaired gag and cough reflexes require assistance in preventing aspiration and maintaining patient airway.

Option A: Assess respiratory function by asking the patient to take a deep breath. Note presence or absence of spontaneous effort and quality of respirations (labored, using accessory muscles). C-1 to C-3 injuries result in complete loss of respiratory function. Injuries at C-4 or C-5 can lead to variable loss of respiratory function, depending on phrenic nerve involvement and diaphragmatic function, but generally cause decreased vital capacity and inspiratory effort.
Option B: If the tongue or relaxed throat muscles are obstructing the airway, a nasopharyngeal or oropharyngeal airway can be inserted; however, the client must have spontaneous respirations when the airway is open.
Option D: The head-tilt, chin-lift maneuver requires neck hyperextension, which can worsen the cervical spine injury. Tilting the head or otherwise moving the neck is contraindicated in a patient with a possible cervical spine injury, but maintaining an airway and ventilation is a greater priority. In the setting of a possible cervical spine injury, the jaw-thrust maneuver, in which the neck is held in a neutral position, is preferred over the head tilt–chin lift maneuver.

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