Airway Assessment & Difficult Airway Planning
Prioritise oxygenation and recognise when airway management needs expert escalation.
Quick revision ↓ Medical Dictionary
01Assess multiple risks
Consider difficulty with mask ventilation, supraglottic devices, intubation and rescue access as distinct problems. Review previous records, anatomy and physiological reserve. Obesity, obstruction or critical illness may shorten tolerance of apnoea, so a plan must address both anatomical and physiological difficulty.
02Prepare and communicate
Discuss the primary and backup airway plans with the team and ensure suitable equipment and skilled help are available. Preoxygenation and positioning are individualised. If difficulty is anticipated, an experienced clinician decides whether an awake or other specialist approach is safer.
03Oxygenation first
Failed intubation does not automatically mean failed oxygenation. Maintain or restore oxygen delivery using the appropriate trained pathway and avoid repeated attempts that cause swelling, bleeding or hypoxia. Calling for help and changing strategy are active safety decisions, not signs to conceal.
04Confirm and secure
Confirm airway position with appropriate waveform capnography and clinical assessment, then secure the device and continue surveillance. A device can move during positioning or transfer. Reassess unexpected changes promptly rather than relying on the original successful placement.
05Extubation strategy
Airway risk continues at emergence. Plan extubation according to consciousness, ventilation, neuromuscular recovery, swelling and the ability to rescue if needed. Document difficulty and inform the patient for future care; uncomplicated insertion does not guarantee uncomplicated removal.
High-Yield Revision
- Plan for oxygenation as well as intubation.
- Limit ineffective repeated attempts.
- Extubation is a planned airway event.
Common Pitfalls
- Persisting with the same failed approach despite worsening oxygenation.
- Assuming a secured airway cannot displace.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 29 September 2026. Consult current local protocols for prescribing, procedures and escalation.