A 28-year-old unrestrained driver involved in a head-on collision is found to have a Glasgow Coma Scale (GCS) score of 6 at the scene (Eyes: 1, Verbal: 2, Motor: 3). According to neurotrauma guidelines, what is the mandatory immediate airway management?

Answer and explanation

Correct answer: D. Endotracheal intubation with rapid sequence induction for airway protection

  1. Step 1: The established neurotrauma threshold is: 'GCS 8 or less, intubate'.
  2. Step 2: Patients with a GCS <= 8 lack protective laryngeal and pharyngeal reflexes, carrying high risk of airway compromise, aspiration of gastric contents, and hypoxemic secondary brain injury.
  3. Step 3: Immediate definitive airway control via endotracheal intubation with cervical spine stabilization is mandatory.
  4. Step 4: Identify endotracheal intubation.
Answer
Endotracheal intubation with rapid sequence induction for airway protection.
Why not the others: 'Bag-valve-mask without intubation' increases gastric insufflation and aspiration risk; 'Oral Guedel airway' is temporary and non-definitive; 'Transfer directly to CT' is unsafe with an unprotected airway.

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