A patient with a severe head injury has a pO2 of 88 and a pCO2 of 48. What should be done to support this patient?
1. Assess oxygen saturation and plan for intubation if saturation is below 86%.
2. Provide 100% oxygen via face mask.
3. Plan for a rapid sequence intubation.
4. Plan for a routine intubation.
3
Rationale 1: An oxygen saturation less than 90% is associated with increased morbidity and mortality in these patients.
Rationale 2: Oxygen would be provided with a bag-valve mask.
Rationale 3: Many organizations utilize rapid sequence intubation, which might include supporting the patient's respirations with a 100% O2 via bag-valve mask; administration of lidocaine to inhibit central responses that can increase ICP; administration of a sedative hypnotic agent; administration of a rapid-acting neuroblocking agent; checking for jaw relaxation after 30 seconds, if it is present; intubation; confirmation of tube placement; and sedation.
Rationale 4: Intubation can be a noxious procedure and may increase intracranial pressure. Because of this, routine intubation would not be done.
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