[Doczilla]

I don't think I'd place an airway adjunct into the wound. You just don't know where you would end up. Though the bubbles indicate that the trachea has been injured, you don't know if the wound tract goes straight into the trachea or just nicked it. If you place an airway adjunct into the hole, it could easily miss the trachea and slide into the paratracheal space, or go all the way through and end up posterior to the trachea. Worst case scenario, you are partially occluding the trachea with the airway adjunct while ventilating soft tissue.

With regards to c-spine, I might collar him to keep him from making sudden movements that might complete the tracheal transection, but any neurological injury is likely to be evident at the time, and if not, extremely unlikely to occur with simple head movement. Full C-spine immob will potentially inhibit the patient from getting into position of comfort, which is where I want him if I'm not intubating immediately. The more comfortable he can get, the better he can breathe, and the less anxious he'll be.

'zilla