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Airway Rescue vs. Difficult Airway

airway management airwaylifeline airwayoptimisation difficult airway safety vortex approach Feb 05, 2024
Unsure of the difference between airway rescue and the difficult airway? Here’s our guide! 😋👉
 
Airway rescue refers to the time you spend in The Vortex between when your first lifeline attempt fails and either you enter the green zone or the declaration of can’t intubate, can’t oxygenate (CICO).
 
🚨 Things to remember while you are in The Vortex 🚨
👉 Management is the same each time and uses the same shared mental model.
👉 You have a maximum of 3 attempts at the 3 lifelines.
👉 Do not try the same lifeline twice without doing something differently.
👉 As each lifeline fails, your CICO status increases!
 
The difficult airway is when we know prior to induction that the airway is going to be difficult, giving us time to plan and prepare for this known difficulty! But how do we know if an airway is going to be difficult?
 
Assessment!!
Here’s our 5 questions for assessing the airway and how to ascertain the answer!
1️⃣ Will intubation be easy?
👉 Personal history, mallampati score, thyromental distance and neck extension.
2️⃣ Will mask ventilation be easy?
👉 MOANS (Mask seal, obesity, age >55, no teeth, sleep apnoea and scarring).
3️⃣ Will an LMA work safely?
👉 RODS (Reduced mouth opening, obstruction, airway distortion, neck extension or lung disease).
4️⃣ How long until the oxygen saturations drop?
👉 Either low oxygen reservoir or high oxygen demand. Can we increase this time?
5️⃣ What is the aspiration risk?
👉 Appropriate fasting, severe reflux or delayed gastric emptying (seen in diabetics and users of Ozempic!).
 
Once these questions have been considered, it’s time to make a plan!
👉 What is our plan A lifeline? Backup?
👉 Will we need a bougie, stylet or videolaryngoscope?
👉 Are we considering an awake intubation?
👉 Do we have all the equipment and personnel we need?
 
Get your hands on a copy of our Anaesthetic Assistant Handbook for our quick guides to airway assessment and all kinds of planning, included with every Premium membership! 😎
 
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