Adult Critical Care Specialty (ACCS) Practice Exam

What is the correct sequence for intubation in a patient with a closed head injury?

1. Preoxygenate, sedation, lidocaine, paralytic, cricoid pressure

2. Lidocaine, sedation, preoxygenate, paralytic, cricoid pressure

3. Preoxygenate, lidocaine, sedation, paralytic, cricoid pressure

4. Sedation, preoxygenate, lidocaine, cricoid pressure, paralytic

The correct answer is: Preoxygenate, lidocaine, sedation, paralytic, cricoid pressure

The correct sequence for intubation in a patient with a closed head injury is essential for ensuring adequate oxygenation and minimizing the risk of complications. Preoxygenation is performed first to maximize oxygen reserves in the patient's lungs and decrease the likelihood of desaturation during the procedure. This step is critical, especially in patients with potential airway compromise due to head injuries. Next, administering lidocaine serves to minimize the cough reflex and prevent increased intracranial pressure (ICP) during intubation. Following lidocaine, sedation is given to ensure the patient is adequately relaxed and minimize any distress, which is especially important in patients who may have elevated ICP due to the head injury. The administration of a paralytic agent follows sedation. This step allows for muscular relaxation, facilitating easier insertion of the endotracheal tube. Lastly, cricoid pressure is applied to help prevent aspiration during intubation, especially important in cases where there is a risk of gastric content being present. This sequence emphasizes the importance of oxygenation and hemodynamic stability in patients with head injuries, aiming to minimize complications linked to their condition. Each step is carefully placed to ensure patient safety and optimal intubation conditions, making this sequence the most appropriate choice for this scenario.