Abstract
Background: Successful airway management is critical to the practice of emergency medicine. Emergency physicians must be ready to optimize and prepare for airway management in critically ill patients with a wide range of physiologic challenges. Challenges in airway management commonly encountered in the emergency department are discussed using a pearl and pitfall discussion in this first part of a 2-part series. Objective: This narrative review presents an evidence-based approach to airway and patient management during endotracheal intubation in challenging cases that are commonly encountered in the emergency department. Discussion: Adverse events during emergent airway management are common, with postintubation cardiac arrest reported in as many as 1 in 25 intubations. Many of these adverse events can be avoided with the proper identification and understanding of the underlying physiology, preparation, and postintubation management. Patients with high-risk features including severe metabolic acidosis; shock and hypotension; obstructive lung disease; pulmonary hypertension, right ventricle failure, and pulmonary embolism; and severe hypoxemia must be managed with airway expertise. Conclusions: This narrative review discusses the pearls and pitfalls of commonly encountered physiologic high-risk intubations with a focus on the emergency clinician.
Original language | English (US) |
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Pages (from-to) | 84-95 |
Number of pages | 12 |
Journal | Journal of Emergency Medicine |
Volume | 59 |
Issue number | 1 |
DOIs | |
State | Published - Jul 2020 |
Keywords
- airway
- hypotension
- hypoxemia
- metabolic acidosis
- obstructive lung disease
- postintubation cardiac arrest
- pulmonary embolism
- pulmonary hypertension
- shock
ASJC Scopus subject areas
- Emergency Medicine