[size=20px]A eight-year old male currently in the trauma bay sustained a gunshot wound to the lateral neck and has an expanding hematoma causing airway compromise. He is combative but breathing spontaneously.

 

The next best step in management of this patient with a gun shot wound to the neck is

 

A decompression of the hematoma.

 

B cricothyroidotomy.

 

C 20 mL/kg lactated Ringer’s solution bolus.

 

D vecuronium and intubation.

 

E midazolam and intubation.[/size]

E

D vecuronium and intubation

E

correct

 

Airway compromise is a significant cause of morbidity in the acutely injured patient. Cricothyrotomies are contraindicated in children less than 12 years of age. In a patient who is breathing spontaneously with a difficult airway such as in this patient, giving a neuromuscular blocker may prove to be a fatal mistake due to loss of airway control and inability to visualize the airway due to the hematoma. In these patients, sedation and maintaining spontaneous breathing while securing an airway is safest.

 

Decompression of the hematoma may induce uncontrollable bleeding and further complicate the situation. While the lactated Ringer’s bolus may be needed for other issues related to resuscitation, it does not specifically address the airway problem.