S2E5 - Difficult Airways

Overall approach to a difficult airwayAlways ask for help!The goal is oxygenation, not intubationYour first attempt is your best attemptDon’t panic!Preoperative Assessment (check out Episode 1 of the series for a review!)Identify risk factors for a potentially difficult airway:Difficult ventilationDifficult intubationDifficulty with patient cooperation/consentDifficult cricothyrotomyOne of the best predictors of a difficult airway is a history of difficult airway Scenario 1: Can't intubate, can ventilateReturn to BMV (bag-mask ventilation) to stabilize the patient and give yourself timeTry something new with each attempt:Switch to a more experienced operatorOptimize patient positionAsk an assistant to apply BURP (backwards upwards rightwards pressure)Try with different equipment (such as a different size ETT, a Bougie, or videolaryngoscope)Minimize the number of attempts (max. 3)Consider using a supraglottic airway device or waking the patient up Scenario 2: Can't intubate, difficult ventilationImprove BMV technique:Use an oropharyngeal or nasopharyngeal airwayOptimize patient positionEnsure the mask has a tight seal, use 2 hands and ask someone else to bagTry inserting a supraglottic airway deviceOnce oxygenation is achieved, consider your options for establishing an airway or waking the patient up Scenario 3: Can't intubate, can't oxygenateRecognize the problem and communicate with the teamProceed with cricothyrotomy / surgical airway Difficult Airway Society Guidelines: https://das.uk.com/guidelines/das_intubation_guidelinesSupport the show

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