3.1. Airway management with RSI: Benefits vs. Risks
Often patients presents in an emergency department (ED) or those treated in the field with a compromised airway and requires urgent airway control and protection to prevent hypoxaemia and secondary brain damage. Unlike in anaesthesia these patients are often none staved, unstable and critically ill. Although they present with a low Glasgow Coma Scale scores their airway protective reflexes might still be intact which increases the risk of aspiration on an intubation attempt. However, with RSI aided intubation the risk of aspiration is reduced due to eradication of the airway protective reflex. Moreover, this provides conducive and easy intubation conditions. RSI also provides a good state …show more content…
The regular assessment findings indicative of a compromised airway include decreased level of consciousness (inability to maintain a patent airway), snoring sounds or stridor (obstructed airway). These patients require an aggressive airway management with the use of RSI (gold standard for intubation). To ensure a high success rate in RSI a thorough assessment of the airway is immensely vital which also helps the clinician anticipate and plan for difficult airway. This is aided by the use of difficult airway predictors which determines the view of the laryngeal structures under direct laryngoscope which requires manipulation of the airway structures to align the axes. The second one determines degree of difficulty by looking and assessing physical features such as the neck mobility, mouth opening, thyromental distance and the degree at which the base of the tongue is likely to occlude the view of pharyngeal structures and this method requires a conscious and sitting patient. These two methods are called Cormack and Lehane and LEMON respectively. However, there has been a huge controversy on positivity and sensitivity as well as application of these methods (Pérez Santos et al
Often patients presents in an emergency department (ED) or those treated in the field with a compromised airway and requires urgent airway control and protection to prevent hypoxaemia and secondary brain damage. Unlike in anaesthesia these patients are often none staved, unstable and critically ill. Although they present with a low Glasgow Coma Scale scores their airway protective reflexes might still be intact which increases the risk of aspiration on an intubation attempt. However, with RSI aided intubation the risk of aspiration is reduced due to eradication of the airway protective reflex. Moreover, this provides conducive and easy intubation conditions. RSI also provides a good state …show more content…
The regular assessment findings indicative of a compromised airway include decreased level of consciousness (inability to maintain a patent airway), snoring sounds or stridor (obstructed airway). These patients require an aggressive airway management with the use of RSI (gold standard for intubation). To ensure a high success rate in RSI a thorough assessment of the airway is immensely vital which also helps the clinician anticipate and plan for difficult airway. This is aided by the use of difficult airway predictors which determines the view of the laryngeal structures under direct laryngoscope which requires manipulation of the airway structures to align the axes. The second one determines degree of difficulty by looking and assessing physical features such as the neck mobility, mouth opening, thyromental distance and the degree at which the base of the tongue is likely to occlude the view of pharyngeal structures and this method requires a conscious and sitting patient. These two methods are called Cormack and Lehane and LEMON respectively. However, there has been a huge controversy on positivity and sensitivity as well as application of these methods (Pérez Santos et al