Context

CAVEAT: While the theory contained in this session provides useful knowledge about airway management, putting this knowledge into practice requires extensive supervised practical experience. Such experience can be reinforced and developed by courses such as the UK TEAM course upon which this session draws extensively.

Airway management in an elective situation is usually straightforward. Any difficulties in airway maintenance and ventilation prior to endotracheal intubation are usually dealt with by simple repositioning manoeuvres and the use of adjuncts [1]. Laryngoscopy usually provides a clear view of the cords and intubation itself is easy.

In the time critical environment of the emergency department, the scenario is complicated by

• Limited scope for prior assessment
• The often poor physiological reserve of the patient
• The potential for a range of pathologies which may still be rapidly evolving

The failure rate for rapid sequence intubation in the emergency department is about 1%, with a cricothyroidotomy rate varying from 0.5% (medical patients) to 2.3% (trauma) [2].

Awareness of indicators of difficulty and techniques to deal with problems can reduce the complication rate [3].