Airway management

Introduction Airway management is one of the core fundamental skills of the emergency medicine or critical care physician. Airway management is time-critical and can literally mean the difference between life and death. Airway management encompasses the overlapping management of oxygenation, ventilation, and airway protection. Airway principles (Table 3.1) Planning, recognizing failure, and decision-making are top priorities. Maintenance of calm permits proper decision-making. Undue haste is detrimental to critical decision-making. Specific time-sensitive exceptions include acidosis, impending airway obstruction, and hypoxia. Each aspect of airway management is modular. Components can be mixed as needed (e.g., video laryngoscopy with a bougie; awake intubation after preoxygenation with noninvasive ventilation). Recognizing failure (Figure 3.1) When first-line techniques fail to result in intubation, early identii cation of failure is paramount. If unsuccessful, laryngoscopy should be abandoned and oxygen restored with mask ventilation. Extraglottic airways (EGA) can be placed quickly and may provide better ventilation than bag-mask ventilation. If an intubation attempt fails and reoxygenation fails, a cricothyroidotomy must be performed immediately. Failure to recognize a “can’t intubate, can’t oxygenate” scenario will result in the patient’s death.