Question for the AW gods........

I think the key is to try not to get yourself in difficult situations in the first place. I coudn't agree more! (un)Fortunately I wasn't the one drinking and popping fist full-o-narcs LOL! The more people that muck around in the airway, the more edema the pt. will have. That was the main issue here. Did you and the PA anticipate her being a difficult airway? Yes, paged anesthesia almost immediately If she was intubated 2 weeks ago, did they have trouble intubating her at that time as well? I had tubed her twice in the 6 weeks prior to this third overdose with relative ease. Why were you having so much difficulty ventilating? Was it just her anatomy (was she fat?) or was she in bronchospasm? The pt is a smoker, so I'm sure there was some bronchospastic component there, however like I posted earlier, lots of edema and loss of muscle tone = no AW patency. You could have tried to place an LMA to see if you could ventilate her better that way, or if your facility has FastTrac LMAs, you could have tried to intubate her that way. I had'nt thought of an LMA, we don't use them outside of the OR here. That is a good suggestion however. Dexamethasone is useful for airway edema, although this certainly would not have helped immediately. Did the anesthesiologist wind up doing a fiberoptic? Yes, we actually use one in the ED. He did have some difficulty but got it. The can't intubate/can't ventilate scenario is every anesthesia provider's worst nightmare, especially when you don't have a surgeon in the hospital who can do an emergency trach!!

What type of airway did you use? You stated a BLS airway, what type?