Basic Airway Management

Airway management is widely preached as the first priority in the management of any seriously ill or injured patient. However, despite the lip service given to the importance of airway management, it is often overlooked and, consequently, can be a source of error in the care of the critically ill or injured patient. Although appropriate airway management is evident in all smoothly run resuscitations, inappropriate management often presages a cycle of patient deterioration and misguided therapeutic intervention.
Unfortunately, recognition of the need for airway management is only the first part of the problem in emergency resuscitation. Managing the airway may be one of the most difficult aspects of the entire resuscitation. Because of the sheer variety of airway difficulties possible, even the most skilled resuscitator can find the task challenging. Blood, loosened teeth, vomitus, swollen or distorted landmarks--all of these present formidable barriers to successful management. When obstruction occurs in conjunction with reflex clenching of the jaws and possible cervical spine injury, conventional airway management tools may be rendered useless. Time pressures imposed by the need to avoid cerebral anoxia force one to make difficult decisions concerning the use of risky maneuvers such as moving the neck, administering paralyzing agents, or using invasive procedures. Tools must be at hand, skills must be well practiced, and decision-making must be sharp if optimal emergency airway management is to occur.
Some solutions to the dilemmas faced in emergency airway management are presented in this and the following chapters. Decision algorithms are presented to help assemble the pieces of the airway management puzzle into a logical framework. Readers are encouraged to study the algorithms at their leisure to facilitate later decision-making when time is limited.