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Difficult airway management outside the operating room

Difficult airway management outside the operating room

RSI: rapid sequence intubation; SpO2: oxygen saturation; PIM: post-intubation management; BMV: bag-mask ventilation; EGA: extraglottic airway device; ILMA: intubating laryngeal mask.

* A failed airway exists when the clinician cannot oxygenate or ventilate a patient. Clinically, this occurs when a patient cannot be intubated and ventilation with a bag and mask or extraglottic device fails to maintain oxyhemoglobin saturations above 90%. Refer to the topic and algorithm discussing management of the failed airway.

¶ During RSI, physiologic derangements such as hypotension and hypoxemia place the patient at great risk of cardiovascular collapse during the peri-intubation period. Possible interventions to prevent such collapse include an intravenous bolus of isotonic fluid and press-dose vasopressor in the hypotensive patient, and flush-rate administration of oxygen and apneic oxygenation in the hypoxic patient. Please refer to UpToDate topics on RSI for further detail.
Reproduced with permission from: The Difficult Airway Course®: Emergency and Brown III CA, Walls RM. The Emergency Airway Algorithms. In: The Walls Manual of Emergency Airway Management, 5th ed, Brown III CA, Sakles JC, Mick NW (Eds), Wolters Kluwer, Philadelphia 2018. Copyright © 2018 Wolters Kluwer.
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