Airway Part 4- What to Do If Intubation Fails

Summary: 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 <a href="https://litfl.com/bougie/">(LITFL)</a>* The 3-step cricothyrotomy <a href="https://emcrit.org/emcrit/modification-scalpel-finger-bougie-technique/">(EMCrit)</a>

Airway Part 4- What to Do If Intubation Fails

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