Tag Archives: difficult airway

Unanticipated difficult intubation – DAS guidelines 2015

Updates & take-home messages:

  • Laryngoscopy -> SAD -> FM ventilation -> cricothyroidotomy
  • If poor view at laryngoscopy remove cricoid under direct vision + suction at hand
  • Use second generation SAD device
  • Removed cricoid for SAD insertion
  • Successful SAD = ‘stop and think’ moment
  • CICO -> paralyse, continue supraglottic O2 attempts -> front-of-neck
  • Laryngeal handshake
  • Front-of-neck = scalpel (No.10, broad blade), bougie, 6.0mm COETT

 

  • Limit the number of airway interventions
  • DO NOT REPEAT SAME TECHNIQUE
  • First attempt is the best. Make it so.
  • Use apnoeic oxygenation in high risk patients
  • Neuromuscular blockade (rocuronium)

https://www.das.uk.com/guidelines/das_intubation_guidelines

Airtraq tips

In a situation where the view is good but difficulty is encountered passed ETT between the cords consider the following:

Manoeuvring Airtraq (+/- head/airway) e.g. ‘drop’ it into pharynx to align angles better

Positioning of the glottis ‘target’ towards bottom right of screen

Use of bougie or wide bore NG tube (with ETT railroaded)

Alternative ETT e.g. standard instead of RAE