The difficult airway

Pre-Intubation

See:

• Predicting the difficult airway
• Apneic oxygenation

ASA Difficult Airway Algorithm

• Does not necessary apply to the ED since the patient can always be awakened and case cancelled
  • Cricothyrotomy should always be the last step in patients with failure to oxygen and ventilate with BVM and inability to intubate
  • Straight blade- Miller- may offer better manipulation of a large epiglottis in children or for micrognathia or "buck teeth"

Intubation Options

Intubation Type	Pros	Cons
Traditional
Awake intubation
Nasal intubation		Lower success rate Higher complication rate (e.g. bleeding, emesis, and airway trauma) Do not attempt in patients with posterior pharyngeal swelling such as in angioedema
Retrograde intubation		Need time to set up Risk hematoma, pneumothorax
Fiberoptic bronchoscopic intubation		Takes time to set up Limited by secretions, bleeding, poor suction,

Surgical Airways

• Surgical cricothyrotomy
• Needle cricothyrotomy
• Pediatric jet ventilation

See Also

Airway Pages

• Pre-intubation
  • Predicting the difficult airway
  • Bag valve mask ventilation
    • Oropharyngeal airway
    • Supraglottic airway
  • Apneic oxygenation
    • EBQ:ED Preoxygenation
• Induction
  • Critical care quick reference
  • Rapid sequence intubation
  • Delayed sequence intubation
• Intubation
  • Intubation (peds)
  • Direct laryngoscopy
  • Video Laryngoscopy
  • Bougie
  • The difficult airway
  • Advanced airway adjuncts
    • Supraglottic airway
  • Non-traditional intubation
    • Awake intubation
    • Nasal intubation
    • Blind digital intubation
• Surgical airways
  • Surgical cricothyrotomy
  • Needle cricothyrotomy
  • Pediatric jet ventilation
• Post-intubation
  • Mechanical ventilation (main)
  • Deterioration after intubation (DOPE)

Video

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