Abstract
Airway management is an essential skill required of every emergency physician. The difficult airway, especially the “can’t intubate, can’t oxygenate” scenario, can be a terrifying experience for even a seasoned emergency physician. One of the most important skills available to the emergency physician is the ability to predict a potentially difficult airway and to have a well thought out backup plan available in case a patient with a difficult airway presents to the emergency department. Complicating the situation is that, in some cases, a difficult airway is not able to be anticipated and the provider can find him/herself suddenly needing to change strategies. This may include using supraglottic airways, video laryngoscopy, endotracheal introducers (bougie), and a myriad of other airway tools. In the event of a “can’t intubate, can’t oxygenate” scenario, the physician must be ready to perform a cricothyrotomy. Proper preoxygenation, preparation with a backup plan, and proper positioning can help to make a potentially disastrous scenario survivable.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Tayal VS, Riggs RW, Marx JA, Tomaszewski CA, Schneider RE. Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period. Acad Emerg Med. 1999;6(1):31–7.
Sakles JC, Laurin EG, Rantapaa AA, Panacek EA. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med. 1998;31(3):325–32.
The walls manual of emergency airway management. 5th ed. 2017.
Carbonell N, Pauwels A, Serfaty L, Fourdan O, Levy VG, Poupon R. Improved survival after variceal bleeding in patients with cirrhosis over the past two decades. Hepatology. 2004;40(3):652–9.
Wang J, Bao YX, Bai M, Zhang YG, Xu WD, Qi XS. Restrictive vs liberal transfusion for upper gastrointestinal bleeding: a meta-analysis of randomized controlled trials. World J Gastroenterol. 2013;19(40):6919–27.
Augustin S, Gonzalez A, Genesca J. Acute esophageal variceal bleeding: current strategies and new perspectives. World J Hepatol. 2010;2(7):261–74.
Blaus B. Medical gallery of Blausen Medical 2014. Wiki J Med. 2014;1(2):10.
Akihisa Y, Hoshijima H, Maruyama K, Koyama Y, Andoh T. Effects of sniffing position for tracheal intubation: a meta-analysis of randomized controlled trials. Am J Emerg Med. 2015;33(11):1606–11.
Roth D, Pace NL, Lee A, Hovhannisyan K, Warenits AM, Arrich J, et al. Airway physical examination tests for detection of difficult airway management in apparently normal adult patients. Cochrane Database Syst Rev. 2018;5:Cd008874.
De Regge M, Vogels C, Monsieurs KG, Calle PA. Retention of ventilation skills of emergency nurses after training with the SMART BAG compared to a standard bag-valve-mask. Resuscitation. 2006;68(3):379–84.
Weingart SD, Levitan RM. Preoxygenation and prevention of desaturation during emergency airway management. Ann Emerg Med. 2012;59(3):165–75.e1.
Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET, et al. Effect of use of a bougie vs endotracheal tube and stylet on first-attempt intubation success among patients with difficult airways undergoing emergency intubation: a randomized clinical trial. JAMA. 2018;319(21):2179–89.
Kei J, Mebust DP. Comparing the effectiveness of a novel suction set-up using an adult endotracheal tube connected to a meconium aspirator vs. a traditional Yankauer suction instrument. J Emerg Med. 2017;52(4):433–7.
Weingart SD, Bhagwan SD. A novel set-up to allow suctioning during direct endotracheal and fiberoptic intubation. J Clin Anesth. 2011;23(6):518–9.
Disclosure Statement
The authors of this chapter report no significant disclosures.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Rublee, C., Barrie, M. (2020). Difficult Airway and OMG, There’s Blood Everywhere: Navigating the Difficult Airway . In: Kaide, C., San Miguel, C. (eds) Case Studies in Emergency Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-22445-5_16
Download citation
DOI: https://doi.org/10.1007/978-3-030-22445-5_16
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-22444-8
Online ISBN: 978-3-030-22445-5
eBook Packages: MedicineMedicine (R0)