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Coda Change

Apr 30, 2017

Ellen O’Sullivan presents an outline of the Difficult Airway Society (DAS) Guidelines on airway management.

Airway management is a fundamental responsibility and skill of all involved especially for emergency physicians, anaesthetists and critical care physicians.

Ellen makes the point that mismanagement of airways leads to severe morbidity and mortality.

She provides a few harrowing examples.

The 2015 Difficult Airway Society guidelines, published in the British Journal of Anaesthesia in December 2015, provide a sequential series of plans (A to D) to implement when tracheal intubation fails.

They promote patient safety by prioritising oxygenation and minimising trauma. Furthermore, they highlight the role of neuromuscular blockade in making airway management easier. The guidelines recognise the difficulties in decision making during an emergency and stress importance of human factor training.

The guidelines include steps to assist the anaesthetic team by providing a common stem of options (a simple algorithm) for maintaining oxygenation, limiting the number of airway intervention attempts, encouraging declaration of failure by placing a Supraglottic Airway Device and overtly recommending a time for stopping and thinking.

They emphasise the importance of considering discontinuing anaesthesia and waking the patient up (if appropriate) when tracheal intubation has failed. The guidelines recommend videolaryngoscopy and second generation Supraglottic Airway Devices. All anaesthetists, intensivists and emergency medicine physicians should be able to use these devices.

There is limited evidence relating to the management of the ‘can’t intubate can’t oxygenate’ situation (CICO) PLAN D. However, all anaesthetists should be able to perform a surgical cricothyroidotomy (and trained accordingly).

Join Ellen as she provides you with what you need to know for management of the difficult airway, in line with the DAS Guidelines.

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