Which sign most strongly indicates potential airway compromise after head injury?

• A. Unequal pupils with one dilated pupil.
• B. Stiff neck.
• C. Drooling or inability to swallow.
• D. Clear speech.

Answer: (C)

After head injury, protecting the airway is the top concern. Drooling or an inability to swallow points most directly to airway compromise because it reflects a loss of protective reflexes that keep the airway clear. When the swallow and gag reflexes are impaired, secretions and blood can pool, raising the risk of aspiration and potential airway obstruction even if breathing looks present initially. That immediate threat to the airway makes this sign the strongest warning.

By comparison, unequal pupils with a dilated pupil flag possible intracranial injury or herniation, which is serious but not a direct measure of airway status. A stiff neck suggests potential cervical spine injury and can complicate airway management, but it does not by itself indicate that the airway is at immediate risk. Clear speech implies the airway is currently protected enough to allow talking, so it argues against an imminent airway problem.