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Chapter 22. Airway Management in the Emergency Department

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All of the following are indications for emergency tracheal intubation EXCEPT

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A. upper airway obstruction

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B. failure to protect the airway

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C. failure to maintain reasonable oxygen saturations

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D. the need for hyperventilation

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E. cardiac arrest

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(A) An emergency surgical airway, not tracheal intubation, is more appropriate for a patient with an upper airway obstruction.

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Responsibility for ensuring appropriate airway management in the ED

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A. rests with the most highly trained practitioner in the room

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B. rests with the anesthesia practitioner, if present

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C. is often unclear

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D. rests primarily with the emergency practitioner of record

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E. should be negotiated at the time

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(D) Responsibility for ensuring appropriate airway management in the ED should rest primarily with the emergency practitioner of record.

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An unconscious 19-year-old morbidly obese male is brought in to the emergency department (ED) by Emergency Health Services (EHS) paramedics, having been found unresponsive at a fraternity initiation party. He had been drinking heavily, although the amount of alcohol consumed is unknown. The patient is unidentified and there is no available past medical history. Respirations are shallow, and paramedics have inserted a nasal trumpet and an oral airway and are assisting ventilations with a bag-mask. They had attempted oral and nasal intubation three times in the field but failed due to the patient being combative and obesity. All of the following are acceptable strategies to employ in managing this airway EXCEPT

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A. moving the patient to the OR for airway management

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B. intubating “earlier rather than later”

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C. performing an awake look, then backing off to perform RSI

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D. intubating awake even if you sense that you can paralyze the patient and be successful at intubation

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E. delaying airway management at all costs until an anesthesia practitioner is present

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(E) Delaying airway management at all costs is not an acceptable strategy in managing an unconscious, morbidly obese patient with difficult ventilation and failed laryngoscopic intubation.

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