Master the board step 3

Section 4
Surgery
contributing author Niket Sonpal, MD
Trauma
Airway
Establishing and securing the airway is always the first step in management
in any patient with acute trauma or change in mental status. Altered mental
status is the most common indication for intubation in the trauma patient
(unconscious patients can’t maintain their airways). The exam will want you
to know the best step in securing an airway.
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Orotracheal intubation is the preferred method of securing an airway.
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If the case describes trauma with cervical spine injury, orotracheal intubation
can still be performed with manual cervical immobilization. The best
answer is the use of a flexible bronchoscope.
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If the case describes extensive facial trauma and bleeding into the airway
(listen for gurgling sounds), cricothyroidotomy is the best answer.
Percutaneous tracheostomy is also acceptable.
Breathing
Always check the oxygen saturation. If the saturation is < 90 percent, do the
following:
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Obtain an arterial blood gas (ABG).
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Determine likely causes of hypoxia based on the history.
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