In a patient with suspected spinal injury and airway obstruction, what is the recommended airway management sequence?

• A. Apply manual inline stabilization, perform jaw-thrust, insert an oropharyngeal airway, suction as needed, ventilate with a bag-valve mask connected to 100% oxygen, reassess, and prepare for an advanced airway if ventilation remains inadequate.
• B. Head-tilt, chin-lift first.
• C. Immediately intubate without inline stabilization.
• D. Use only nasal cannula oxygen.

Answer: (A)

In a patient with suspected spinal injury and airway obstruction, the priority is to protect the spine while securing and opening the airway. Start with manual inline stabilization to prevent neck movements during airway management. Open the airway with a jaw-thrust rather than a head-tilt/chin-lift, since the latter can extend or flex the cervical spine and worsen potential injury. If the patient is unconscious and has no gag reflex, place an oropharyngeal airway to maintain patency, and suction as needed to clear secretions or obstructions. Begin ventilation with a bag-valve mask delivering 100% oxygen, reassessing to ensure effective ventilation. If ventilation remains inadequate, proceed to an advanced airway while maintaining inline stabilization. Nasal cannula alone does not manage airway obstruction and cannot secure the airway, and attempting intubation without stabilization risks further injury or delay.