The Difficult Airway

1. The Difficult Airway Dr. Richard Lee, MD, FRCPC Division of Emergency Medicine University of Alberta

2. Objectives: To be aware of the unique circumstances surrounding the emergency intubation. To be familiar with the indications for emergency intubation. To be able to asses and recognize potentially difficult airway situations.

3. Objectives (cont.): To be familiar with certain rescue airway techniques. To develop an algorithm for the difficult airway.

4. The Emergency Intubation: Emergency Department Full stomach Unknown medical history Multisystem involvement Intubate or die Operating Room Empty stomach �Cleared� medically One system involved Can always cancel OR until your day off.

5. The �Emergency� Intubation Emergency physicians are the experts in �emergency� intubations. 27% of 143 anesthesia programs in the US had a rotation dedicated to managing the difficult airway and most of this was lectures only (Koppel et al 1995) 91% successful intubation rate for EM residents vs. 66% for non-EM residents (Barton et al. 1998) Must be skilled, competent and knowledgeable about intubation and rescue techniques.

6. Indications for Emergency Intubation Failure to maintain and protect the airway. Failure to ventilate. Failure to oxygenate. To provide supplemental therapy hyperventilation, pulmonary toilet etc. Anticipation of any of the above.

7. Predictors of a Difficult Airway Mallampati and Cormack-Lehane scores used alone are unreliable. Use a combination of clinical features and clinical judgement. Anything that inhibits the alignment of the oral, pharyngeal and laryngeal axis will make intubation more dificult.