emDocs - July 3, 2015 - Authors: Nabers G and Canion A
Edited by: Koyfman A and Long B.
"Summary
Awake orotracheal and nasotracheal intubation are two skills that all emergency medicine physicians should have in their airway “tool kit.” All emergency medicine residency trained physicians will be well-trained in the ins and outs of rapid sequence intubation, but rarely utilize this integral skill. Much of this is due to the accessibility of a specialist such as surgeon, ENT, or anesthesiologist to assist with airway control in more difficult patient scenarios; however, this will not always be the case in actual practice. Being able to identify the difficult airway and when RSI may cause significant morbidity and mortality as well as the alternate options of awake intubation is paramount to the success of every EM physician. During my 3rd year of residency we had a patient being transferred to our facility from a small outlying hospital with the presentation and outcome of the first scenario above. I discussed with my attending why this patient was not intubated using a technique such as awake intubation and the reply was simple. Many community physicians, EM trained or not, don’t know how to do it. It is our responsibility to not only treat patients in response to pathology, but to also anticipate a patient’s course and intervene early to prevent decompensation. Awake intubation should be utilized to prevent a difficult airway from becoming an impossible airway."
http://www.emdocs.net/awake-endotracheal-intubation/