ENARE Practice Questions - ENARE - Exame Nacional De Residências (Brazil) Exam

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A 28-year-old male driver is brought to the emergency department following a high-speed frontal motor vehicle collision. He presents with severe midface fractures, massive oral hemorrhage, and gurgling respiration. Bag-valve-mask ventilation is unsuccessful due to altered facial anatomy, and endotracheal intubation via direct laryngoscopy fails due to persistent blood obscuring the vocal cords. The patient's oxygen saturation drops to 74% and heart rate is 138 bpm. According to ATLS guidelines, what is the most appropriate next step in securing a definitive airway?

Immediate surgical cricothyroidotomy. Repeated blind orotracheal intubation with a bougie. Placement of a supraglottic laryngeal mask airway (LMA) as a permanent definitive airway. Emergency bedside formal tracheostomy.

Correct Answer:

Immediate surgical cricothyroidotomy.

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