MAXIM: The most important initial airway intervention may be to ask for help.
Clinical scenarios where asking for help may be necessary include:
Laryngeal injury/tracheal disruption, for whom a nonendoscopic intubation attempt can result in tracheal disruption and fatally lost airway (see Fig. 22.4)
Recent neck surgery, with pending loss of airway from an expanding hematoma; definitive and life-saving intervention in this case is to open up the recent incision and evacuate the hematoma.
Suspected epiglottitis, where an immediate operative tracheostomy or cricothyroidotomy may be required if intubation fails due to epiglottic edema.
Severe angioedema with tongue and oropharynx swelling where endotracheal or nasotracheal intubation may be obstructed (see Fig. 22.5).
Severe facial edema after burns or trauma (see Fig. 22.6).
Laryngeal Fracture. This 17-year-old male was kicked in the neck by a bull at a rodeo causing a laryngeal fracture. (Photo contributor: Rudy Kink, MD.)
Angioedema. This patient with ACE inhibitor angioedema and respiratory failure required awake fiber optic nasotracheal intubation by anesthesia. (Photo contributor: David Effron, MD.)
Flash Cigarette Burns. This patient with tobacco dependence disorder and oxygen-dependent chronic obstructive pulmonary disease developed facial burns when his cigarette and nasal canula ignited while lighting a cigarette. These patients typically have partial-thickness facial burns and no airway injury. Intubation is rarely needed. (Photo contributor: Lawrence B. Stack MD.)
Emergency physicians are emergency airway experts, but know your limitations.
Do not let your ego get in the way of proper patient airway management and care.