difficult airway algorithm

Step 1 assess the likely hood and clinical impact of basic management problems
difficult ventilation
difficult intubation
difficulty with pt cooperation and consent
difficult tracheostomy

Step 2
Actively pursue opportunities to delivery supplemental O2 throughout the difficult airway manaement

step 3
consider relative merits and feasibility of basic management

step 3 A.
Awake intubation
vs
Intubation attempts after induction of GA

step 3 B
noninvasive technique for initial approach to intubation
vs
invasive technique for initial approach to intubation

step 3 C
preservation of spontaneous ventilation
vs
Ablation of spontaneous ventilation

Step 4
Develop primary and alternative strategies

Awake intubation 1.
airway approach by noninvasive intubation
or
airway secured by invasive access

Awake intubation for noninvasive
succeed
or
failed

awake intubation for failed noninvasive
cancel case
consider feasibility of other options
invasive airway access

Intubation attempts after induction of GA
initial intubation attempt was successful
or
attempts were unsuccessful
consider
1. calling for help
2. return to spontaneous breathing
3. awakening the pt

unsuccessful attempts after induction
Face mask ventilation adequate
or
face mask ventilation inadequate

FM adequate ventilation becomes
non emergency pathway
ventilation adequate, intubation unsuccessful

after ventilation adequate, intubation unsuccessful
alternative approach to intubation

after alternative approach to intubation
successful intubation
or
failed after multiple attempts

failed after multiple attempts consider
Invasive airway ventilation
feasibility of other options (a)
awaken the pt

face mask ventilation inadequate consider
Attempt LMA

LMA adequate go to non emergency pathway
ventilation adequate and
intubation was unssuceesful

LMA not adequate or not feasible got to
emergency pathway

emergency pathway
unable to ventilate
intubation successful

unable to ventilate
intubation successful
call for help

after call for help proceed to
emergency non invasive airway ventilation

emergency non invasive airway ventilation
successful ventilation
or
failed

successful emergency non invasive airway ventilation consider
Invasive airway ventilation
feasibility of other options (a)
awaken the p

failed emergency non invasive airway ventilation proceed
Emergency invasive airway access

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