Approach to blunt cerebrovascular injury Quiz: Ace Your Exams
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A 22-year-old man is brought to the emergency department (ED) for evaluation after being assaulted. Paramedics report the patient was strangled by an assailant and was found unresponsive at the scene. A cervical collar was applied prior to arrival at the ED. The patient has no significant past medical history and does not take any medication daily. Temperature is 37.0 °C (98.6 °F), pulse is 102/min, respirations are 30/min, blood pressure is 177/84 mmHg, and oxygen saturation is 67% on room air. The patient appears cyanotic and responds to a sternal rub. There is a large ecchymosis around the left orbit and a large left scalp hematoma. There is also significant ecchymosis and swelling of the neck. Glasgow coma score (GCS) is 6, and pupils are equal, round, and reactive to light. Intravenous access is established, and supplemental oxygen is applied via non-rebreather. Rapid sequence intubation is attempted, but upon entering the airway, marked edema and bleeding is noted, and the vocal cords cannot be visualized. Which of the following is the best next step in management?
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