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Difficult Airway Management in Emergency Care

Strategic algorithm for unanticipated difficult intubation in the emergency department.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Acil Servis department. Book Appointment →

What is Difficult Airway Management in Emergency Care?

Difficult airway is defined as the situation where a clinician with intubation experience cannot establish definitive airway with traditional laryngoscopy. Approximately 5-10% of emergency department intubations are difficult, while emergency surgical airway is required in 1-2%.

Predicting difficulty: LEMON (Look, Evaluate, Mallampati, Obstruction, Neck mobility), MOANS (mask ventilation difficulty) and SHORT (cricothyrotomy difficulty) scores are used. Cervical immobilization, facial trauma, cervical pathology and obesity increase difficulty.

The algorithm progresses through awake fiberoptic intubation, video laryngoscopy (GlideScope, McGrath), supraglottic airway (LMA, i-gel), bougie, and emergency cricothyrotomy. Adequate preparation and rapid sequence intubation (RSI) success are vital.

Symptoms

Anatomic abnormalities (micrognathia, retrognathia)
Cervical immobilization and trauma
Severe facial-neck swelling
High Mallampati score (III-IV)
Restricted mouth opening
Restricted cervical motion

Risk Factors

Obesity (BMI >40)
Cervical trauma and stabilization
Mandibular fracture and facial trauma
Burn victim and facial swelling
Pregnancy (third trimester)
Anatomic anomaly (Pierre-Robin, Treacher-Collins)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Severe shortness of breath
  • Stridor and progressive airway obstruction
  • Loss of consciousness and apnea
  • Severe trauma (facial-cervical)
  • Airway burn or angioedema
  • Cardiopulmonary arrest

Treatment Methods

01
Difficulty risk scoring (LEMON, MOANS)
02
Awake fiberoptic intubation
03
Video laryngoscopy (GlideScope, McGrath)
04
Supraglottic airway (LMA, i-gel)
05
Bougie-assisted intubation
06
Emergency cricothyrotomy (failure scenario)

Which Department to Visit?

You can visit our Acil Servis department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Acil Servis Department

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You can make an appointment with our specialists or contact us for your concerns.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.