Airway Part 4- What to Do If Intubation Fails

Verbalize the out loud prior to performing rapid sequence intubation.

The Bougie

* Ideal for situations when you’re view is suboptimal* Advance it through the cords and into the trachea BEFORE the endotracheal tube. It will stay in place and guide the tube into position (this is called a Seldinger technique).

Video Laryngoscopy (Glidescope)

* Laryngoscope with a camera at the tip which displays on a screen at bedside* Ideal for situations when both view and direct access to the cords is suboptimal (c-collar, poor mallampati). Some physicians use this as their primary technique. * Use it like a camera that you advance into position so you can see the cords. Maneuver the endotracheal tube by watching indirectly on the screen.

Flexible Endoscopy

* It is a flexible stylet that you can control and has a camera at the tip.* Advances through the cords like a bougie and the (preloaded) endotracheal tube advances over it. * Can intubate through both the nose or mouth with this

LMA (laryngeal mask airway)

* Placed blindly and sits above the cords, forming a seal. * Not a “definitive” airway, but can oxygenate and ventilate the patient when in a difficult situation.

Cricothyrotomy

* Immediately perform this step in “can’t intubate can’t oxygenate” situations* The 3-step EMCrit method is best in my opinion (see link below)* “Scalpel, Finger, Bougie”

Additional Reading

* Overview of the bougie with videos (LITFL)* The 3-step cricothyrotomy (EMCrit)