During evaluation of a patient with facial trauma and dislodged teeth after a motor vehicle crash, which management step should be performed?

• A. Fully immobilize her spine, locate the dislodged teeth, suction as needed, and transport
• B. Assist ventilations with a BVM device, immobilize the spine, suction oropharynx for 30 seconds, and transport
• C. Fully immobilize her spine, irrigate empty tooth sockets, attempt to locate the dislodged teeth, and transport
• D. Apply oxygen via a nonrebreathing mask, suction her airway as needed, disregard the dislodged teeth, and transport

Answer: (A)

Protecting the airway while preventing further spine injury is the top priority in facial trauma with suspected cervical injury. The best immediate step is to fully immobilize the spine, locate the dislodged teeth so they can be preserved for potential reimplantation, clear the airway with suction as needed to keep it free from blood and debris, and then transport. Locating and preserving the teeth at the scene can aid later dental care, and suction helps prevent aspiration during transport. Irrigating tooth sockets or disregarding the teeth isn’t appropriate for field management, and while airway support is important, the option that best integrates spine protection, tooth localization, suction, and rapid transport is the most comprehensive approach.