In a patient with suspected basilar skull fracture, which airway adjunct is contraindicated?

• A. Oropharyngeal airway
• B. Endotracheal tube
• C. Nasal airway
• D. Bag-valve mask

Answer: (C)

The main idea is to avoid nasal airways when basilar skull fracture is suspected. A fracture at the base of the skull, often involving the cribiform plate, creates a pathway through which a nasal airway can be driven into the cranial cavity. This can cause intracranial injury, bleeding, or introduce infection (meningitis) and CSF leakage. Because of that risk, a nasal airway is contraindicated in these patients.

If the airway needs to be managed, an oropharyngeal airway can be used in an unconscious patient without a gag reflex, a definitive airway can be secured with endotracheal intubation, and bag-valve-mask ventilation is used to maintain oxygenation while airway control is established.