Skip to content

Do not struggle against the patient


Emerg Med Int, 2010 vol. 2010 pp. 826231
Difficult Airway Management Algorithm in Emergency Medicine: Do Not Struggle against the Patient, Just Skip to Next Step
Sudrial, J; Birlouez, C; Guillerm, AL; Sebbah, JL; Amathieu, R; Dhonneur, G

We report a case of prehospital “cannot intubate” and “cannot ventilate” scenarios successfully managed by strictly following a difficult airway management algorithm. Five airway devices were used: the Macintosh laryngoscope, the gum elastic Eschmann bougie, the LMA Fastrach, the Melker cricothyrotomy cannula, and the flexible fiberscope. Although several airway devices were used, overall airway management duration was relatively short, at 20 min, because for each scenario, failed primary and secondary backup devices were quickly abandoned after 2 failed attempts, each attempt of no more than 2 min in duration, in favor of the tertiary rescue device. Equally, all three of these rescue devices failed, an uncuffed cricothyroidotomy cannula was inserted to restore optimal arterial oxygenation until a definitive airway was secured in the ICU using a flexible fiberscope. Our case reinforces the need to strictly follow a difficult airway management algorithm that employs a limited number of effective devices and techniques, and highlights the imperative for early activation of successive preplanned steps of the algorithm.

Address: Prehospital Emergency Medicine Department, General Hospital Gonesse, 95500, France.

2 Comments Post a comment
  1. As you know, this is my bug bear – the need for a well-thought out and articulated plan (I like the UK’s Difficult Airway Society algorithms), a checklist before attempting intubation and a verbal run-through with ‘cutoff’s’ for interjection (if SPO2 falls below 90% you will direct me to do X)…but most importantly a number of SIMPLE, RELIABLE and AFFORDABLE devices that you have trained with in elective situations

    Probably more thought goes into this in the prehospital and EM arenas than for rural doctors – because our exposure to these events is often limited. But all the more reason for ‘occasional intubators’ to have drills and hands on training

    December 14, 2012
  2. “Relatively short” and 20 minutes aren’t exactly the same (perhaps they meant SI time, I still use English units). 5 devices seems like a lot to me too.

    The LMA worked initially, so I wonder why it wasn’t left in place until they were certain they had optimized oxygenation. The LMA failed after two intubation attempts thru it, which sounds like it became unseated or as the authors believe the epiglottis came down front.

    Very interesting conclusion from the authors given the case description, “It is now time to identify that the early performance of infraglottic (surgical) airway techniques may be life saving.”

    December 15, 2012

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s


In memory of Dr John Hinds

Dr. Smith's ECG Blog

In memory of Dr John Hinds


"Live as if you will die tomorrow; Learn as if you will live forever"

Songs or Stories

Sharing the Science and Art of Paediatric Anaesthesia


In memory of Dr John Hinds

"Sweat the small stuff...."

"If someone is willing to teach you something for free, take them up on it. Do it. Every single time. All it does is make you more likely to succeed. And its kind of a nice way to go through life...."

Liz Crowe

Wellbeing Counsellor and Educator


In memory of Dr John Hinds

EM Basic

Your Boot Camp Guide to Emergency Medicine

Ash Witt

In memory of Dr John Hinds


Ramblings from a gasdoc with interests in #anaesthesia, #intensivecare, #echo, #PHEM and #FOAM

PulmCrit: Pulmonary Intensivist's Blog

In memory of Dr John Hinds

Miss Chardy

Laughter in the Outback

The Collective

A Hive Mind for Prehospital and Retrieval Med

Bits & Bumps

Obstetrics and Gynaecology FOAM


Why FOAM it alone?

In memory of Dr John Hinds


Or "How I'm Learning to Stop Worrying and Love Emergency Medicine"


A great site

Genevieve's anthology

Writings to amuse, teach, inspire and entertain.

JR Paramedic

In memory of Dr John Hinds

Monash Anaesthesia

In memory of Dr John Hinds


A topnotch site


Bringing the boring to emergency medicine


Navigating resuscitation

Doctor's bag

by Dr Edwin Kruys

EM nerd

In memory of Dr John Hinds

The Chart Review

In memory of Dr John Hinds

ETM Course

Emergency Trauma Management Course

The Doctor's Dilemma

Modern Medical Musings from Dr Marlene Pearce

Sim and Choppers

A blog combining medical education, simulation and helicopter retrieval medicine


Reflections of a Rural GP

Auckland HEMS

Unofficial site for prehospital care providers of the Auckland HEMS service

Rural Doctors Net

useful resources for rural clinicians


Searching for the big picture in intensive care

Nomadic GP

Adventures of a Rural Locum


Free Open Access Medical Education for Paramedics

Not just a GP

Why GP is the greatest job in the world

the short coat

In memory of Dr John Hinds


Bringing the Boring to EM

When your shift turns to shit? Keep moving, keep caring!

KI Doc

Kangaroo Island doctor blogging about Rural Medicine in Australia


pulling apart cases from the ED...

Little Medic

Learning everything I can from everywhere I can. This is my little blog to keep track of new things medical, paramedical and pre-hospital from a student's perspective.


Prehospital Emergency Medicine


Just another site

In memory of Dr John Hinds

Intensive Care Network

In memory of Dr John Hinds


Get every new post delivered to your Inbox.

Join 10,767 other followers

%d bloggers like this: