In suspected TBI, endotracheal intubation is typically indicated when?

• A. GCS ≤8 or failure to protect airway
• B. GCS ≥13
• C. SpO2 above 95% on room air
• D. Temperature above 38C

Answer: (A)

The key idea is airway protection in a brain-injured patient. A Glasgow Coma Scale score of eight or less signals a deep level of unconsciousness with impaired protective airway reflexes (like gag and cough), making spontaneous airway protection unreliable. In this situation, securing the airway with endotracheal intubation safeguards ventilation and oxygen delivery, reducing the risk of hypoxia and aspiration and allowing controlled support for breathing, which is crucial to minimize secondary brain injury.

Options describing a higher GCS, adequate oxygen saturation on room air, or fever do not by themselves justify intubation: a higher GCS means the patient likely can protect the airway, normal SpO2 indicates adequate oxygenation, and fever doesn’t directly address airway protection.