Difficult Intubation
You’ve heard the story: The intubation became more difficult than expected. Several attempts were made to improve visualization of the glottis and pass the endotracheal tube. The efforts failed. Ventilation became difficult and then impossible. What started as a routine procedure suddenly became a life-threatening emergency - Christine E. Whitten MD
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HWN Suggests
The Difficult Airway: Common Errors During Intubation
Intubation in the ED often entails a chaotic environment, which requires a calm amid the storm in order to maintain sound judgment while making life-and-death decisions. A stepwise approach is needed to ensure no key steps were missed when deciding if a patient needs to be intubated, how the patient should be intubated, if it will be a difficult intubation, and how the difficult airway should be managed...
Upon recognition of the “can’t intubate, can’t ventilate” scenario, the decision to perform a cricothyrotomy must be made immediately, prior to the patient suffering from a hypoxic cardiac arrest. Cricothyrotomy is not a failure of endotracheal airway management; rather, it is a lifesaving…
Articles of Interest
Airway trauma during difficult intubation… from the frying pan into the fire?
We report a case of an unanticipated difficult intubation, where the bougie, used to secure the airway, led to bronchial injury.
Anticipated Difficult Intubation: Should I Intubate The Patient Awake?
Many providers are uncomfortable with performing awake intubations and leave it as a last resort.
Difficult Airway Algorithms
All intubation attempts should be considered potential difficult airways.
Intubation With Airway Bleeding and Massive Emesis
We’re used to being able to rapidly suction the mouth clear or secretions, blood, or vomit and then have a clear view of the larynx. But sometimes, either because of continued profuse bleeding or massive emesis, fluid continues to accumulate while we’re watching. How can you manage this situation and successfully intubate?
The 'difficult' airway
There are generally three options for oxygenation in the unanticipated difficult airway: 1. Bag-mask ventilation, 2. supraglottic airway, and 3. intubation. FONA is the rescue technique if these three don't work. The VORTEX approach calls these options the three 'lifelines'.
The difficult airway in the emergency department
The difficult airway is a challenge to both the emergency physician and the anaesthetist. Its incidence in the ED is understandably higher as there is a disproportionately larger number of patients requiring airway management as a result of acute medical or surgical conditions which by themselves contribute to the difficulty. Examples of these would be maxillofacial trauma, respiratory burns and the various causes of laryngeal oedema. Airway management in the ED often occurs in an unpredictable and uncontrolled environment, sometimes with the patient arriving unannounced.
Resources
Difficult Airway Society
Welcome to the website of the Difficult Airway Society (DAS), the UK’s foremost medical specialty society dedicated to further the management of the airway of patients by anaesthetists, critical care and other related practitioners.
StatPearls
A difficult airway is a clinical situation in which a healthcare provider who is skilled at airway management encounters difficulty with one or more standard methods of airway management. The definition is not standardized in the literature and there are some variations between national expert guidelines.
The Difficult Airway Course
The definitive course for airway management education.
