Failed Airway

RedCell · Jul 31, 2007

Cannot mask ventilate? cannot intubate? Try waking the patient up if possible. Otherwise, if there is no lightwand, fast-track, or fiberoptic around that buys the poor sucker a quick trip through the cricothyroid membrane with a 14 gauge angiocath. I guess if you really wanted to get creative you could always try a retrograde intubation, but the patient would probably be hypoxic as hell by the time you saw the guidewire.

neneRN, BSN, RN · Jul 31, 2007

We always have more than one ER doc on duty at a time, if one is having a difficult intubation, we'll grab another to come try, also we have some great RTs who have been known to get the tube when the ER doc hasn't. Use the fiber-optic occasionally. If no one in ER can get it, we overhead a code 100 and any available anesthesiologist comes. Worst case scenerio, we get out the cric tray and make our own airway!

GilaRRT · Jul 31, 2007

Curious, is anybody using supraglottic devices to rescue the failed airway? I know this is quite common and effective in the EMS environment; however, is it utilized within the hospital? In addition, are docs using Gum Elastic Bougies and ELM for the difficult airways?

granite109 · Aug 1, 2007

About 3 years ago, our institution initiated the airway cart. It's like a code cart with the drawers and all. All of the RSI meds are in there, the standard ETTs and laryngoscopes; in addition to rescue devices; including the LMA, combitube (or King LT), and a Rhino brand trach tray. We have the lighted laryngoscope and the lighted stylet. They usually go to a trach instead of a cric in the ER; but we do cric in the field. It's certainly less than optimal; as the previous poster stated, hypoxia has usually set in by then and it's badness.

On a difficult airway, anesthesia usually gets called if the patient can still be adequatley ventilated, rather than using a rescue device. However, more and more, the literature is supporting less attempts at ET intubation if difficult, and earlier use of the rescue airway. It's a paradigm shift, so it will interesting to see what transpires. When all else fails, a BLS airway still provides oxygen!