Neurological Disorders Q 88

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Nurse Mary witnesses a neighbor’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 in this victim by using which method?

  

     A. Flexed position

     B. Head tilt-chin lift

     C. Jaw-thrust maneuver

     D. Modified head tilt-chin lift

    

    

Correct Answer: C. Jaw-thrust maneuver

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If a neck injury is suspected, the jaw thrust maneuver is used to open the airway. The jaw thrust maneuver more directly lifts the hyoid bone and tongue away from the posterior pharyngeal wall by subluxating the mandible forward onto the sliding part of the temporomandibular joint (mandibular advancement).

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Option A: A flexed position is an inappropriate position for opening the airway. Direct laryngoscopy and tracheal intubation is one of the basic and the most important skills in anesthetic practice. This requires proper positioning of head and neck to adequately visualize the glottis and easily negotiate the tracheal tube through the glottic opening. The position traditionally recommended and taught to all learners of airway management is the “sniffing position” (SP). This involves neck flexion (head elevation) by putting a pillow under the head and then extending the head at the atlanto-occipital joint.

Option B: The head tilt–chin lift maneuver produces hyperextension of the neck and could cause complications if a neck injury is present. To relieve upper airway obstruction, the clinician uses two hands to extend the patient’s neck. While one hand applies downward pressure to the patient’s forehead, the tips of the index and middle fingers of the second hand lift the mandible at the chin, which lifts the tongue from the posterior pharynx. The head-tilt/chin-lift maneuver may be used in any patient in whom cervical spine injury is NOT a concern.

Option D: To perform the head-tilt maneuver, approach the patient from the side and place the palm of one hand on the patient’s forehead and push down gently, rolling the patient’s head towards the top. Then, using the fingers of your free hand, lightly lift the chin even further up.

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