The Difficult Airway Algorithm

The Inevitable Airway Crisis

If you're like me, losing an airway is your worst nightmare. You've probably seen attendings gracefully manage difficult intubations, but the reality is, on the boards, they are going to take your preferred tools away. What actually ends up happening is they back you into a corner.

The Safety Choice: AFOI

If the stem gives you a massive neck mass and prior radiation, don't play cowboy. State: "I will proceed with an Awake Fiberoptic Intubation (AFOI). This maintains spontaneous ventilation." It shows consultant-level restraint.

The CICO Transition

When intubation and LMA placement fail, don't drag it out. "We are in a Cannot Intubate, Cannot Oxygenate (CICO) scenario. I will immediately perform an emergency surgical airway." This decisiveness passes the exam.

Example: Extubation Strategy

The airway crisis doesn't end after intubation. Mention using an airway exchange catheter and confirming a cuff leak prior to pulling the tube.

FAQs: Board Airway Management

Do I always need to mention a surgical airway?

You absolutely must verbalize the transition to a definitive surgical airway anytime non-invasive ventilation paths fail.

Conclusion

Follow the ASA algorithm rigidly. Know when to wake the patient up, and know precisely when to cut the neck.