Difficult Airway Algorithm 1. Assess the ikethood and clinical impact ol basic management problems. ‘A Difficult ventilation B. Difficult intubation G.Diffcuity with patient cooperation or eansent B, Diticut tracheostomy 2. Actively pursue opportunities 10 deliver supplemental oxygen throughout the process of dificult airway management 3. Consider the relative merits and leasibilty of basic management chaices: Intubation attempts after Sone leleiation “| induction of general anesthesia | Noninvasive technique for initial sive technique fo inital proach to intubation —|¥®| —_approactto intubation Preservation of spontaneous |, | Ablation of spontaneous ventilation " ‘ventilation 4. Develop primary and alternative strategies. ‘Awake intubation Airway approached by Airway secured by oninvasve intubation invasve access* 8. Intubation Attempts after induction Of General Anesthesia Initia intubation Initial intubation atternpts ‘attempts UNSUCCESSFUL successtut" FROM THIS POINT ONWARD. CONSIDER 4. Calling or help. 2. Returning to spontaneous ventilation 8. Awakening the patient Succeed" FAIL i + 4 Cancel Consider feasibilty Invasive case __ofother options® __access** Face mask ventilation adequate Face mask ventilation not adequate ' Considerlattempt LMA LMA adequate’ —_LMAnot adequate or not foasiblo Nonemergency Pathway a Emergency Pathway ‘Ventilation adequate, intubation unsuccesstul ‘Ventilation inadequate, intubation unsuccessful Call for help ‘Aternative approdches to intubabon® Y Emergeney noninvasive airveay ventilation® ‘Sucoasstul intubation’ FAIL after multiple attempts Succosstul vortiation* FAIL —> Emergoncy a imasive sieway lavasive airoary ventilation Consider feasibity of other options* Awaken patient? access! opyright ©2006 by The McSraw-Hill Companies, Ine. All nabs rerarved,