Airway Part 4- What to Do If Intubation Fails
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 3 February 2019
⏱️ 11 minutes
🧾️ Download transcript
Summary
Verbalize the out loud prior to performing rapid sequence intubation.
The Bougie
* Ideal for situations when you’re view is suboptimal* Advance it through the cords and into the trachea BEFORE the endotracheal tube. It will stay in place and guide the tube into position (this is called a Seldinger technique).
Video Laryngoscopy (Glidescope)
* Laryngoscope with a camera at the tip which displays on a screen at bedside* Ideal for situations when both view and direct access to the cords is suboptimal (c-collar, poor mallampati). Some physicians use this as their primary technique. * Use it like a camera that you advance into position so you can see the cords. Maneuver the endotracheal tube by watching indirectly on the screen.
Flexible Endoscopy
* It is a flexible stylet that you can control and has a camera at the tip.* Advances through the cords like a bougie and the (preloaded) endotracheal tube advances over it. * Can intubate through both the nose or mouth with this
LMA (laryngeal mask airway)
* Placed blindly and sits above the cords, forming a seal. * Not a “definitive” airway, but can oxygenate and ventilate the patient when in a difficult situation.
Cricothyrotomy
* Immediately perform this step in “can’t intubate can’t oxygenate” situations* The 3-step EMCrit method is best in my opinion (see link below)* “Scalpel, Finger, Bougie”
Additional Reading
* Overview of the bougie with videos (LITFL)* The 3-step cricothyrotomy (EMCrit)
Transcript
Click on a timestamp to play from that location
| 0:00.0 | Hello, med students. |
| 0:02.7 | My name is Zach Olson, and thank you for downloading this week's episode of the EM Clerkship |
| 0:08.0 | Podcast. |
| 0:09.4 | Okay. |
| 0:10.4 | So far, airway. |
| 0:11.6 | Phase one, suction and move the tongue. |
| 0:13.6 | Phase two, basic airway, bag valve mask adjuncts, naso and oropharyngeal airways. Phase three, pre-oxygenation, RSI, the |
| 0:26.5 | intubation procedure. And today, the final phase, phase four, this is kind of expert level |
| 0:32.4 | stuff, but I'm just going to give you an introduction to it, difficult airways. Your plan B, what to do when things aren't going right and you an introduction to it. Difficult airways. |
| 0:42.2 | Your plan B, what to do when things aren't going right and you can't really get the tube in and things are just not working. |
| 0:44.8 | If you get a chance to do airways on your rotation, your attending is going to want you |
| 0:48.9 | to verbalize a backup plan. |
| 0:52.0 | And last week, we mentioned how you're supposed to say five things out loud so that |
| 0:56.1 | you're attending knows that you've prepared equipment and one of those things was like a laryngeal |
| 1:00.9 | mask airway. But what you're doing here is you're verbalizing that you have a plan B and a plan C. |
| 1:07.9 | This is very important for you now. And forever and ever, you need to have a backup |
| 1:12.9 | plan. And really, there are five choices for your backup plan, five kind of classic options. |
| 1:20.7 | And we're just going to go over briefly the five airway fallbacks today. And this is going to |
| 1:26.6 | be more for when you're a little more |
| 1:28.5 | advanced and you've gotten good at intubation and things like that. So you've suction, you've moved |
| 1:33.2 | the tongue, you've bagged, you've put in the nasal pharyngeal or the oropharyngeal airway adjuncts, |
| 1:40.1 | you pre-oxygenated, and then crap, you miss the tube. |
... |
Please login to see the full transcript.
Disclaimer: The podcast and artwork embedded on this page are from Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD, and are the property of its owner and not affiliated with or endorsed by Tapesearch.
Generated transcripts are the property of Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD and are distributed freely under the Fair Use doctrine. Transcripts generated by Tapesearch are not guaranteed to be accurate.
Copyright © Tapesearch 2026.