- Why has ENW! posted this
It is an important revision of the leading document defining "Practice
Guidelines for Management of the Difficult Airway". Critical airway management and
confronting a "difficult airway" are essential components of Emergency Medicine
and an inescapable responsibility.
- Why is this document significant?
These guidelines for management of the difficult airway are the only
authoritative declaration upon the subject. The evaluation and process suggested are the
basis of approaching such problems. As such, it will be cited in any expert testimony or
- But, its from anesthesiologists, --not Emergency
Yes. Anesthesiologists have, over a decade, formalized their review of such
problems and through these guidelines, improved monitoring, improved and new equipment
have lowered the incidence and liability of airway problems. While Emergency Medicine has
had articles, text material, and courses upon Difficult Airway Management, no organized
body for the specialty has defined such a document.
- Why should I be aware of this document?
It is important for the Emergency Nurse to be aware of what may be asserted as
"Standard of Care", to follow evolution of approach and management, and to be
fully prepared to assist at each step that may occur until the airway is secured and the
management thereafter until the patient arrives at his next destination.
- Whats different about the guidelines now?
An evidence-based review; updating due to literature, experience, new
equipment since the last revision; a greater role of alternative airways (LMA®,
Combitube®, jet stylets) before invasive/surgical airways
- How else will this affect me?
It is likely that you will have additional airway equipment in the department with which
to be competent. The more closely you understand the physicians thinking and plan,
the more ready and apt you will be when moments are critical.
- What elements might help anticipate a potential
- What likely alternative airway methods must I be ready
- What airway equipment is likely to be stocked?
- So, whats the algorithm? (Understanding that
it was devised for anesthesia in an operating room setting)
- What else should my department do?
It should review any present plan; determine any adaptation needed; procure and train upon
any new equipment, and implement any new procedures; ensure all staff are prepared and
have competencies verified. While Emergency Medicine in your institution must define what
it will do and plan appropriately, it should consult and coordinate collegially with
available anesthesia back-up.
"Difficult Airway Sidebar - Commentary for Emergency Nurses Upon the New Guidelines from ASA"
is a webarticle presented by:
Emergency Nursing World ! [http://ENW.org]
©Tom Trimble, RN [Tom@ENW.org]
The illustrations are from
Anesthesiology 2003; 98(5):1269-1277
Copyright © 2003 American Society of Anesthesiologists. All rights reserved
Published by Lippincott Williams & Wilkins