Airway Compromise in Face and Neck Trauma Practice Questions

25 multiple-choice questions on Airway compromise in face and neck trauma for paramedic and EMT students, from Chapter 34 (Face and Neck Trauma). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. A 30-year-old man was kicked repeatedly in the face and has multiple facial fractures. The most immediate threat to his life is:

   1. A. Airway obstruction
   2. B. Loss of vision
   3. C. Disfigurement
   4. D. Facial nerve injury
   Show answer

   Answer: A. Airway obstruction

   Blood, broken teeth, swelling, and loss of jaw support can block the airway within minutes. Facial wounds look dramatic, but the airway decides survival.

2. A 24-year-old man was struck in the face with a baseball bat. He is conscious, his mouth is filling with blood, and he has no signs of spinal injury. The best position for him is:

   1. A. Supine with the head tilted back
   2. B. Supine on a long backboard
   3. C. Sitting up and leaning forward
   4. D. Prone with the head turned
   Show answer

   Answer: C. Sitting up and leaning forward

   Sitting forward lets blood and secretions drain out of the mouth rather than into the airway. Lying supine lets blood pool in the pharynx and be aspirated.

3. A patient with major facial injuries needs spinal motion restriction and is vomiting blood. The best way to protect the airway while keeping the spine aligned is to:

   1. A. Sit the patient up on the cot
   2. B. Log roll the patient onto the side
   3. C. Tilt the head back and suction
   4. D. Insert a nasopharyngeal airway first
   Show answer

   Answer: B. Log roll the patient onto the side

   Rolling the patient as a unit lets the mouth drain while keeping the spine in line. Sitting the patient up moves the spine and is reserved for patients without a spinal concern.

4. Which suction device is best for clearing large amounts of blood and clots from the mouth of a facial trauma patient?

   1. A. A soft, flexible French catheter
   2. B. A bulb syringe
   3. C. A small-bore flexible pediatric catheter
   4. D. A large-bore rigid suction catheter
   Show answer

   Answer: D. A large-bore rigid suction catheter

   A rigid tonsil-tip or large-bore catheter removes blood and clots quickly. Soft French catheters are for the nose and endotracheal tubes and clog easily with clots.

5. A facial trauma patient's mouth keeps filling with blood, and his SpO2 falls to 84% while you suction. The best approach is to:

   1. A. Keep suctioning until it is all clear
   2. B. Stop suctioning and only give oxygen
   3. C. Alternate suction with oxygenation
   4. D. Wait for the SpO2 to recover alone
   Show answer

   Answer: C. Alternate suction with oxygenation

   In a bleeding airway, suction is essential, but prolonged attempts cause hypoxia. Suction in short bursts, then oxygenate or ventilate, and repeat, while positioning to drain blood and preparing a definitive airway. Continuous suction worsens hypoxia, and stopping suction lets blood obstruct and be aspirated.

6. A patient with bilateral mandible fractures has snoring respirations. The most likely cause of the obstruction is:

   1. A. Laryngeal spasm
   2. B. The tongue falling back
   3. C. Swelling of the epiglottis
   4. D. A crushed cricoid ring
   Show answer

   Answer: B. The tongue falling back

   With the mandible broken on both sides, the tongue loses its anterior support and falls against the posterior pharynx. A jaw thrust or pulling the fragment forward can relieve it.

7. A patient with a Le Fort fracture has a mobile midface pushed back against the pharynx, and air movement is poor. You can improve the airway by:

   1. A. Grasping the maxilla and pulling forward
   2. B. Inserting a nasopharyngeal airway
   3. C. Packing the nose with gauze
   4. D. Placing the patient in the Trendelenburg position
   Show answer

   Answer: A. Grasping the maxilla and pulling forward

   Pulling the loose midface forward and up can lift it off the airway. A nasal airway is avoided because it can enter the cranial vault through a fractured cribriform plate.

8. In a patient with suspected midface fractures and clear fluid draining from the nose, you should avoid:

   1. A. Oral suctioning
   2. B. Oropharyngeal airway insertion
   3. C. Nasotracheal intubation
   4. D. Bag-mask ventilation
   Show answer

   Answer: C. Nasotracheal intubation

   Clear nasal fluid suggests a basilar skull fracture, and a tube passed through the nose can enter the cranial vault. Oral routes and suctioning remain appropriate.

9. You are ventilating a 45-year-old woman with multiple facial fractures by bag-mask, and her SpO2 keeps falling. The most likely reason ventilation is difficult is that:

   1. A. The lungs are usually injured
   2. B. Oxygen cannot pass through blood
   3. C. Ventilation raises the ICP
   4. D. A mask seal is hard to obtain
   Show answer

   Answer: D. A mask seal is hard to obtain

   Unstable bones, swelling, and bleeding prevent a good seal, so two-person technique with an oral airway is often needed. Lung injury is not the reason facial trauma makes the mask seal hard.

10. A trauma patient's airway is full of blood, and you plan oral intubation. The suction-assisted technique (SALAD) involves:

    1. A. Suctioning only after the tube is placed
    2. B. Leading the laryngoscope with a rigid suction tip
    3. C. Passing a soft suction catheter through the nose first
    4. D. Withholding suction until the cords are seen
    Show answer

    Answer: B. Leading the laryngoscope with a rigid suction tip

    With SALAD, the rigid catheter clears the path ahead of the blade and can be parked in the esophagus or left side of the mouth during the attempt. Waiting until the cords are visible means you may never see them.

11. A 30-year-old woman has a gunshot wound that has destroyed most of her mandible. She is awake, sitting forward, and drooling blood, with an SpO2 of 95%. The best initial approach is to:

    1. A. Let her keep the position she prefers
    2. B. Lay her supine to prepare for intubation
    3. C. Insert an oropharyngeal airway
    4. D. Perform a needle cricothyrotomy
    Show answer

    Answer: A. Let her keep the position she prefers

    An awake patient who is protecting her own airway is safest in the position she has chosen. Forcing her supine can cause sudden complete obstruction; prepare for a surgical airway in case she deteriorates.

12. Airway compromise after blunt anterior neck trauma may be delayed because:

    1. A. Edema and hematoma expand over hours
    2. B. The vocal cords go into delayed spasm
    3. C. Supplemental oxygen dries the mucosa
    4. D. Blood is absorbed into the lungs
    Show answer

    Answer: A. Edema and hematoma expand over hours

    Swelling of the larynx and a slowly expanding hematoma can narrow the airway long after the injury. Reassess repeatedly and prepare for a difficult airway even if the patient initially looks well. Delayed laryngospasm and drying from oxygen are not the usual mechanism, and blood is not absorbed into the lungs; the narrowing comes from swelling and bleeding in the neck.

13. A 25-year-old hockey player was struck in the anterior neck by a stick. Which finding most strongly suggests a laryngeal injury that will threaten the airway?

    1. A. A mild sore throat with a normal voice
    2. B. Sore neck muscles
    3. C. Pain on turning the head
    4. D. Stridor and hoarseness
    Show answer

    Answer: D. Stridor and hoarseness

    Stridor means narrowing at the larynx, and hoarseness means the vocal cords are involved. Neck pain on turning the head is nonspecific and does not by itself point to the airway. A sore throat with a normal voice or sore neck muscles may follow a blow but does not signal laryngeal narrowing.

14. The primary indication for a surgical cricothyrotomy in a facial trauma patient is:

    1. A. Any fracture of the nasal bones
    2. B. Inability to intubate or ventilate
    3. C. Any patient with a GCS below 8
    4. D. Failure of a first oral airway attempt
    Show answer

    Answer: B. Inability to intubate or ventilate

    Surgical cricothyrotomy is the rescue for a can't-intubate, can't-oxygenate situation, often caused by massive facial bleeding or distortion. A low GCS calls for airway management but usually by less invasive means first.

15. For a surgical cricothyrotomy in an adult, the preferred tube is usually:

    1. A. A 9.0 uncuffed tracheal tube
    2. B. A nasopharyngeal airway
    3. C. A 6.0 cuffed tracheal tube
    4. D. A large-bore IV catheter
    Show answer

    Answer: C. A 6.0 cuffed tracheal tube

    A small cuffed tube (about 6.0 mm, either an endotracheal or tracheostomy tube) fits through the cricothyroid membrane and allows effective ventilation and protection from aspiration. A 9.0 tube is too large for the opening, a nasal airway cannot be secured or cuffed, and an IV catheter is used for needle cricothyrotomy, not surgical.

16. A 6-year-old with massive facial trauma cannot be ventilated or intubated. Surgical cricothyrotomy is generally avoided in a child this age because:

    1. A. Their tracheal rings are complete
    2. B. The membrane is small and hard to find
    3. C. Their larynx sits lower in the neck than in adults
    4. D. They do not tolerate oxygen well
    Show answer

    Answer: B. The membrane is small and hard to find

    In children younger than about 10 to 12 years, the cricothyroid membrane is tiny and the cricoid supports the airway, so needle cricothyrotomy is preferred. The pediatric larynx is higher in the neck, not lower.

17. During a surgical cricothyrotomy, after the skin incision you should next:

    1. A. Insert the tube through the skin incision
    2. B. Inflate the tube cuff
    3. C. Cut the cricoid cartilage
    4. D. Incise the cricothyroid membrane
    Show answer

    Answer: D. Incise the cricothyroid membrane

    Make a vertical skin incision, then a horizontal incision through the membrane, then open it and insert the tube. Cutting the cricoid ring can collapse the airway.

18. A stabbing victim has a gaping wound low in the neck with the cut end of the trachea visible. He is cyanotic, air moves only through the wound, and oral intubation has failed. If your protocol allows it, the best way to secure the airway is to:

    1. A. Pass a tube through the wound into the trachea
    2. B. Close the wound with an occlusive dressing
    3. C. Perform a surgical cricothyrotomy above the wound
    4. D. Insert a supraglottic airway device
    Show answer

    Answer: A. Pass a tube through the wound into the trachea

    When the distal trachea is open and visible and oral intubation has failed, placing a cuffed tube (often over a bougie) directly into the distal tracheal opening under direct vision is the fastest way to restore ventilation. Hold the tube and the tracheal edge so the trachea cannot retract into the chest, inflate the cuff, and confirm with waveform capnography. This is a last-resort rescue that many systems permit only by medical director protocol, so follow your local scope. An occlusive dressing would seal the only route air is moving through and cause complete obstruction. A cricothyrotomy enters the airway above a low tracheal transection, so it cannot bypass the injury. A supraglottic device sits above the larynx, so ventilated gas would escape out of the tracheal wound instead of reaching the lungs.

19. You are preparing to intubate a patient with facial trauma. Which equipment should be ready before the first attempt?

    1. A. A nasotracheal tube set
    2. B. A soft French suction catheter
    3. C. A surgical airway kit
    4. D. A pediatric bag-mask
    Show answer

    Answer: C. A surgical airway kit

    Facial trauma is a predictable difficult airway, so the backup plan, including a surgical airway kit, should be ready before you start. Nasal intubation is avoided with possible midface fractures, a soft catheter cannot keep up with heavy bleeding, and a pediatric bag-mask is the wrong size for an adult rescue.

20. A patient with facial injuries has an oral airway in place and is being ventilated, but gastric distention is increasing. The most likely cause is:

    1. A. An oral airway that is too short for the patient
    2. B. Ventilating too fast or with too much volume
    3. C. An airway obstructed by the tongue
    4. D. Blood that has entered the stomach
    Show answer

    Answer: B. Ventilating too fast or with too much volume

    High pressures from fast or forceful ventilation open the esophagus and fill the stomach, raising the risk of vomiting and aspiration. Swallowed blood can fill the stomach too, but it does not cause progressive distention during ventilation.

21. A patient with blunt laryngeal trauma, hoarseness, and subcutaneous emphysema still has adequate breathing. Which airway approach carries the greatest risk?

    1. A. Blind insertion of a supraglottic device
    2. B. High-flow oxygen by mask
    3. C. Close observation in position of comfort
    4. D. Preparation for a surgical airway
    Show answer

    Answer: A. Blind insertion of a supraglottic device

    Blind devices can push through a fractured larynx and create a false passage, turning a partial obstruction into a complete one. Oxygen and close monitoring with backup ready are appropriate.

22. Which patient most clearly needs a definitive airway before transport?

    1. A. A nasal fracture with mild epistaxis
    2. B. A chin laceration with normal speech
    3. C. Facial burns, stridor, and a hoarse voice
    4. D. An isolated orbital fracture with diplopia
    Show answer

    Answer: C. Facial burns, stridor, and a hoarse voice

    Stridor and hoarseness after facial burns mean the upper airway is already swelling and may close soon. Diplopia from an orbital fracture is a vision problem, not an airway threat.

23. A facial trauma patient has a loose, broken upper denture in his mouth. You should:

    1. A. Leave it in place to improve the mask seal
    2. B. Push it back into position against the palate
    3. C. Leave it until the patient is intubated
    4. D. Remove it so it cannot obstruct the airway
    Show answer

    Answer: D. Remove it so it cannot obstruct the airway

    Loose or broken dentures can be aspirated or block the airway, so remove them. Intact, well-fitting dentures may be left in to help the mask seal, but a broken plate gives no support and is a foreign body.

24. A patient with facial trauma vomits while restrained on a backboard. Your first action should be to:

    1. A. Tilt the board onto its side and suction
    2. B. Remove the cervical collar to clear the mouth
    3. C. Wait for the vomiting to stop before suctioning
    4. D. Sit the patient up to clear the vomitus
    Show answer

    Answer: A. Tilt the board onto its side and suction

    Turning the whole board keeps the spine in line while gravity drains the mouth, and suction clears the rest. Removing the collar or sitting the patient up abandons spinal precautions.

25. Right after a surgical cricothyrotomy, bagging produces rapidly spreading swelling and crackling in the neck, and there is no waveform on capnography. The most likely problem is:

    1. A. The patient has a pneumothorax
    2. B. The tube is in the right mainstem
    3. C. The capnography line is kinked
    4. D. The tube is outside the airway
    Show answer

    Answer: D. The tube is outside the airway

    Subcutaneous air spreading with each breath and no ETCO2 waveform indicate a false passage in front of the trachea. Remove the tube and reattempt placement through the membrane, confirming with capnography. A pneumothorax or a mainstem tube would still show an ETCO2 waveform, and a kinked sampling line would not explain the spreading neck swelling.