Case 1

An obese 62-year-old man has been knocked down by a car.

Review the case history on the right.

You agree with the trauma team anaesthetist that intubation is indicated. What features in the information provided indicate that bag mask ventilation may be difficult? What other indicators of difficulty with BVM ventilation may be visible? See if you can list three main features and two other features that may be visible.

Now see if you can identify three features in the information provided that indicate that intubation may be technically difficult.

Having identified that there is great potential for difficulty when performing RSI on this man, your anaesthetic colleague is looking rather stressed.

He has prepared his laryngoscope and size 8, 8.5 and 9 endotracheal tubes but is looking around rather anxiously for something else (perhaps inspiration?) while preoxygenating the patient.

After suggesting that you get someone to see if one of his senior colleagues is immediately available you set about seeing how else you can help.

List five pieces of equipment that would be useful to have immediately to hand.

The anaesthetist is clearly having trouble at his first attempt at intubation. He has been suctioning repeatedly and seems unable to be able to get a clear view. The patient’s saturations, having been 100% after preoxygenation, have reached 92%.

What would you suggest at this point?

Happily, it proves possible to oxygenate the patient and his saturations rapidly return to 100%.

What should your anaesthetic colleague do now?