If there is suspicion of neurological injury and the patient has SpO2 below 90% despite high-flow oxygen, which action is indicated?

If there is suspicion of neurological injury and the patient has SpO2 below 90% despite high-flow oxygen, which action is indicated?

• A. Reassess in 5 minutes
• B. Assist ventilations with a BVM
• C. Administer aspirin
• D. Increase IV fluids

Answer: (B)

Maintaining airway and ventilation is the priority in suspected neurological injury. If SpO2 is under 90% despite high-flow oxygen, the patient isn’t being adequately ventilated, and simply continuing oxygen won’t correct the problem. The best action is to assist ventilations with a bag-valve-mask. This provides controlled breaths and increases the amount of air reaching the lungs, which raises oxygen delivery to the brain and helps prevent secondary injury. As you assist ventilation, ensure a good mask seal, manual cervical spine protection if injury is suspected, and suction as needed. Deliver breaths at a rate appropriate for an adult (roughly one breath every 5–6 seconds, about 10–12 per minute) with chest rise, and reassess frequently with pulse oximetry. If oxygenation remains poor after BVM ventilation, escalate to an advanced airway per protocol. Avoid delaying ventilation while waiting to reassess or administering non-indicated treatments such as aspirin in this scenario, and IV fluids won’t correct hypoxemia on their own.

Maintaining airway and ventilation is the priority in suspected neurological injury. If SpO2 is under 90% despite high-flow oxygen, the patient isn’t being adequately ventilated, and simply continuing oxygen won’t correct the problem. The best action is to assist ventilations with a bag-valve-mask. This provides controlled breaths and increases the amount of air reaching the lungs, which raises oxygen delivery to the brain and helps prevent secondary injury.

As you assist ventilation, ensure a good mask seal, manual cervical spine protection if injury is suspected, and suction as needed. Deliver breaths at a rate appropriate for an adult (roughly one breath every 5–6 seconds, about 10–12 per minute) with chest rise, and reassess frequently with pulse oximetry. If oxygenation remains poor after BVM ventilation, escalate to an advanced airway per protocol. Avoid delaying ventilation while waiting to reassess or administering non-indicated treatments such as aspirin in this scenario, and IV fluids won’t correct hypoxemia on their own.