A patient in a multiple-vehicle accident displays signs of aspiration and significant neck trauma. What should the respiratory therapist recommend?

In a scenario where a patient has experienced significant neck trauma along with signs of aspiration, the most suitable recommendation is to perform oral intubation with a bronchoscope. This approach is critical for several reasons.

First, oral intubation allows for a direct and secure method of establishing an airway, which is essential in cases of severe trauma and potential airway compromise due to aspiration. Using a bronchoscope during the intubation helps visualize the airway more clearly, which is especially important in patients with neck injuries where anatomy can be distorted or obscured.

Furthermore, the use of a bronchoscope can assist in identifying and managing any immediate complications, such as blood in the airway or tracheobronchial injuries, which may not be easily seen without direct visualization. It also facilitates suctioning of secretions or aspirated material if necessary, thus improving the likelihood of successful airway management in an emergency setting.

In contrast, the other methods listed are less appropriate given the context of neck trauma and the risk of aspiration. An oral airway or nasopharyngeal airway could further obstruct the airway in a trauma patient, especially with potential facial or skull injuries. Blind nasal intubation is particularly risky in trauma cases due to the potential for entering