In a patient with a suspected severe head injury, what should you do if they are unconscious and showing extensor posturing?

In cases of severe head injury, particularly when a patient is unconscious and exhibiting extensor posturing, immediate attention to airway management and ventilation is crucial. The indication of extensor posturing suggests significant neurologic impairment, which puts the patient at high risk for airway obstruction.

Performing bag-mask ventilation at a rate of 20 breaths per minute helps to ensure that the unconscious patient is receiving adequate oxygenation and ventilation. This method is essential, as it can assist in maintaining a patent airway and ensure that carbon dioxide is being expelled, thus providing necessary respiratory support.

Other options may not be appropriate due to different considerations. For instance, inserting an oropharyngeal airway might not be effective if the gag reflex is absent, and administering oxygen alone does not address potential airway problems. Nasotracheal intubation may be contraindicated because of the risk of craniofacial injuries leading to further complications. Applying a non-rebreather mask without securing the airway first may also be insufficient and risky. Therefore, bag-mask ventilation is the most immediate and effective step in this scenario.