Despite a myriad of recommendations, there will undoubtedly be unanticipated difficulty with airway management. When navigating the difficult airway algorithm, decision points hinge on whether or not oxygenation and ventilation are adequate. The two arms of the flow chart start with either induction of general anesthesia or performing an awake intubation. Most difficulty in common anesthesia practice occurs after the induction of anesthesia has taken place and will initially focus on this arm of the flow chart. Once general anesthesia has been induced by a trained anesthesia provider and intubation has been unsuccessful, the patient is classified as having a difficult airway and swift decisions need to take place. The most important consideration is whether or not mask ventilation is adequate. All ventilation should be confirmed with exhaled CO2, in addition to other means of assessing ventilation. Once mask ventilation has been established, the urgency is removed, allowing for nonemergent techniques to establish oxygenation and ventilation. These techniques can include anything from alternate methods of noninvasive airway access, to invasive airway access, to awakening the patient, and choosing an alternate plan. If mask ventilation is not adequate and awakening the patient is not an option, alternate means to establish ventilation are needed. Consider placing a supraglottic airway device, such as an Laryngeal mask airway (LMA) to aid with ventilation and call for help. If ventilation is still inadequate with the supraglottic airway device, then invasive access is necessary. Supplemental oxygen should be delivered while other modalities of securing the airway are in process. Methods of invasive airway access include a surgical airway such as tracheostomy, percutaneous cricothyrotomy, percutaneous jet ventilation, and retrograde wire intubation.