difficult airway algorithm
plan A
- Tracheal intubation
maximise chance of success by:
- Optimise head and neck position
- Preoxygenate
- Adequate neuromuscular blockade
- Direct / Video Laryngoscopy (maximum 3+1 attempts)
- External laryngeal manipulation
- Bougie
- Remove cricoid pressure
- Maintain oxygenation and anaesthesia
If fail, move to
plan B
- Supraglottic airway device
- IF SUCCEED, consider:
- Wake the patient up
- Intubate trachea via the SAD
- Proceed without intubating the trachea
- Tracheostomy or cricothyroidotomy
If fail, move to
plan C
- Face mask ventilation - 2 person technique
- Paralyse
- IF SUCCEED: wake patient up
plan D
- FONA - Cricothyroidotomy
limitations of the algorithm
- predicated on perioperative setting, i.e. theatre patients you can reverse and wake up. This is obviously less applicable in critically unwell ICU/ED patients.