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Emergency Medicine International
Volume 2010, Article ID 826231, 3 pages
Case Report

Difficult Airway Management Algorithm in Emergency Medicine: Do Not Struggle against the Patient, Just Skip to Next Step

1Prehospital Emergency Medicine Department, General Hospital Gonesse, 95500, France
2Anesthesia and Intensive Care and Emergency Medicine Department, Jean Verdier University Hospital of Paris, 93143 Bondy, France
3Département d'Anesthésie et Réanimation, CHU de l'APHP, Jean Verdier, Av du 14 Juillet, 93143 Bondy, France

Received 1 February 2010; Revised 26 May 2010; Accepted 15 June 2010

Academic Editor: Walter Mauritz

Copyright © 2010 Jérôme Sudrial et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We report a case of prehospital “cannot intubate” and “cannot ventilate” scenarios successfully managed by strictly following a difficult airway management algorithm. Five airway devices were used: the Macintosh laryngoscope, the gum elastic Eschmann bougie, the LMA Fastrach, the Melker cricothyrotomy cannula, and the flexible fiberscope. Although several airway devices were used, overall airway management duration was relatively short, at 20 min, because for each scenario, failed primary and secondary backup devices were quickly abandoned after 2 failed attempts, each attempt of no more than 2 min in duration, in favor of the tertiary rescue device. Equally, all three of these rescue devices failed, an uncuffed cricothyroidotomy cannula was inserted to restore optimal arterial oxygenation until a definitive airway was secured in the ICU using a flexible fiberscope. Our case reinforces the need to strictly follow a difficult airway management algorithm that employs a limited number of effective devices and techniques, and highlights the imperative for early activation of successive preplanned steps of the algorithm.