Difficult airway

Question 1

First four steps of the dificult airway algorythm

(stop at the algorithm)

Answer 1

1. Asssess the likelyhood of basic management problems
   
   • Difficult ventilation
   • Difficult intubation
   • Difficulty with consent or cooperation
   • Difficult tracheostomy
2. ​Deliver supplimental oxygen throughout
3. Consider merits and feasible management choices:
   
   1. Awake vs intubation after general anesthesia
   2. Non-invasive vs invasive technique to intubation
   3. Preservation vs Ablation of spontaneious ventilation
4. ​Develop primary and alternative strategies

Question 2

Develop primary and alternative strategies

Side A

Answer 2

1. Awake intubation
   
   • invasive or non-invasive approach to intubation
2. If this FAILS
   
   • Cancel case
   • consider feasibility of other options
   • if you attempted a non-invasive approach - you can attempt an invasive approach

Question 3

Develop primary and alternative strategies

Side B

Non-emergency pathway

Answer 3

1. The initial intubation was unsucessful
2. Consiter from here on:
   
   1. Calling for help
   2. Returning to spontaneous ventilation
   3. awakening the pateint
3. ​If you are ABLE to mask ventilate it is the NON-EMERGENCY pathway
   
   • ​this means the intubation failed but ventilation is adequate
4. ​​Alternate approaches to intubation
   
   • ​​try a different blade
   • use the LMA as a conduit
   • Use and intubating stylet
   • Retrograde intubation
   • Light Wand
   • Blind oral/nasal intubation
5. ​Still fail after multiple attempts
   
   • ​Consider invasive airway access (tracheostomy, cricothyrotomy)
   • Consider other feasible options
   • Awaken the patient

Question 4

Develop primary and alternative strategies

Side B

Emergency pathway

Answer 4

1. The initial intubation was unsucessful
2. Consiter from here on:
   
   • Calling for help
   • Returning to spontaneous ventilation
   • awakening the pateint
3. If facemask ventilation is not adequate
   
   • Consider/Attempt an LMA
4. ​If the LMA is not feasible and you are UNABLE to mask ventilate it is the EMERGENCY pathway
   
   • ​this means the intubation failed unable to provide adequate ventilation
5. ​​​CALL FOR HELP!!!
6. Emergency NON-Invasive airway ventilation
   
   • ​Rigid bronchoscope
   • Esophageal-tracheal combitube ventilation
   • Transtracheal jet ventilation
7. ​If this fails go to INVASIVE airway ventilation
   
   • ​tracheostomy
   • cricothyrotomy

Question 5

Difficult Airway Management

Pink one

Answer 5

Question 6

ASA Difficult Airway Algorythm

Answer 6