Knowledge Base

Airway Emergency

Knowledge Base

title: "Airway Emergency"

Airway Emergency

Key Facts

In an airway emergency, prioritise oxygenation over intubation attempts.

If you can’t oxygenate with basic manoeuvres, escalate early to supraglottic airway and call for help.

Overview

This article covers recognition of the crashing airway, immediate manoeuvres, and escalation.

Recognise the emergency

  • Stridor, gurgling, inability to speak, silent chest
  • Increasing work of breathing, altered conscious state, cyanosis
  • Rapidly falling SpO₂ or ventilation failure (rising CO₂)

Immediate actions (while calling for help)

  1. Reposition: head-tilt/chin-lift or jaw thrust (if c-spine risk)
  2. Clear the airway: suction, remove visible obstruction
  3. High-flow O₂ + two-person BVM with a good seal
  4. Consider adjuncts: OPA/NPA if tolerated

Escalation

  • If BVM is failing: early supraglottic airway (iGel/LMA)
  • Prepare for RSI with full backup (difficult airway plan)
  • If "can't intubate, can't oxygenate": proceed to emergency front-of-neck access per local protocol
Cormack-Lehane: Grade 1 (full cords) to 4 (no glottis visible) - helps plan backup strategies

Sources

  • CC Bible
  • Local airway guidelines

Test Your Knowledge

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In a crashing airway where SpO₂ is falling, what is the immediate priority while the team prepares for RSI (Rapid Sequence Intubation)?
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Related Topics

See also: Endotracheal Intubation, Anaphylaxis, Cervical Spine Injury