A 20-Year-Old Man Is Brought to the Emergency Department After

A 20-year-old man is brought to the emergency department after falling off a trampoline.  He had been drinking alcohol with some friends and began jumping on a trampoline in his neighbor's backyard.  The patient tried to do a backflip and landed on his head.  Paramedics were called and found him confused but able to follow commands.  However, he was unable to move his legs or his hands.  The patient was placed in spine immobilization and transported to the emergency department.  On arrival, his vital signs are within normal limits, but he has increasing shortness of breath and requests to sit up to help his breathing.  Chest x-ray is normal, and ECG reveals sinus tachycardia.  Over the next 30 minutes, his respirations become faster and shallower with more use of accessory muscles.  The patient becomes sleepier and has difficulty responding to commands.  Which of the following is the most appropriate next step in management?

A) Nasotracheal intubation
B) Needle cricothyroidotomy
C) Noninvasive positive pressure ventilation
D) Orotracheal intubation
E) Surgical tracheostomy

Correct Answer:

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