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Santa Claus : would he be a difficult airway?

santa18 (1)

Hi there

Would Santa Claus be a difficult intubation ? Difficult face mask ventilation? Difficult surgical airway?

Lets hypothetically say, you are awoken in the middle of Christmas eve night? You rush out to catch the prowler in your house to find Santa Claus collapsed before the Christmas tree. His face is blackened and his beard half burnt. You immediately diagnose he is suffering acute facial burn due to falling face down into the roaring fire place whilst trying to negotiate your chimney.

Poor Santa is moaning and starting to struggle to breathe. he is coughing up black sputum.

Lucky for Santa but you have your full prehospital intubation kit with RSI drugs sitting in house, as part of being on call for the holiday season.

Now it probably does not matter much doing a difficult airway assessment on Santa right now..he is going to die soon if you dont do something and a lot of children are relying upon you to save Santa.

But lets try to consider a difficult airway assessment on the visage of bearded man in the red suit.

Difficulty in face mask ventilation?

He has a big beard even if half burnt off. Tricky to get good mask seal. Lets face it..tough mask ventilation but not impossible with two person BVM.

Difficulty in preoxygenation?

He probably does have sleep apnoea given his red cheeks and large rounded face and BMI. Lets be honest , he looks obese. he will desaturate quicker..

Difficulty in supraglottic airway use?

Maybe..maybe not. To be honest he would be someone I would prefer the Rapid Sequence Airway a la Dr Darren Braude…if it was not a case of an airway burn injury.

Difficulty in orotracheal intubation?

He has obesity as a risk factor..not sure of his Mouth opening nor his Hyoid-mental and Thyroid-hyoid distances. Dont know about his neck mobility. He might be an easy intubation but still not reassuring as if sole strategy is get tube in on first pass, not good. If unexpectedly difficult intubation, the other options like SGA and BVM oxygenation may well fail.

Difficulty in surgical airway?

Hard to tell as that big beard tends to hide his neck completely! That alone makes it a harder surgical airway. Do we have enough time to shave it all off to access the neck anatomy better? If half is burnt off that is helpful but what if it was not and a fully bearded Santa Claus needed a surgical airway due to failed intubation and SGA oxygenation?

Maybe an USS guided cricothyrotomy?


Ideally you do an emergency double setup as outlined by Dr Reuben Strayer.

You go to Cric Con level 3 0r 2 on the scale espoused by Dr Scott Weingart here


Luckily you manage to orally intubate Santa Claus on first pass with RSI technique. He is not a difficult intubation after all!

But he could have been…right?

2 Comments Post a comment
  1. Ben Hoffman #

    Using the tablet I am gonna buy myself for Christmas I’ve managed a nosey at Santa’s PMHx

    1) severe ischaemic heart disease with 90% occulsion of the LAD
    2) diabetes type II
    3) gout
    4) hypercholesterolaemia
    5) stage 3 hypertension requiring 2 different diuretics, an ACE inhibitor and beta blocker
    6) arthritis
    7) couple of fused vertebrae from carrying all those presents
    8) bilateral knee replacements
    9) some form of cancer
    10) depression
    11) alcoholism
    12) GERD
    13) IBS
    14) mitral valve regurg
    15) LVH with orthopnea

    … I dno about you mate but I might have a word to the Reindeer about the appropriateness of keeping Santa ventilated in ICU given his extensive comorbidities and poor HRQOL

    December 25, 2012

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