1 Introduction and Overview

Introduction Effective airway management is central to the care of critically ill and injured patients. Competency in assessment and maintenance of the airway using basic airway manoeuvres first, followed by advanced skills such as rapid sequence induction of anaesthesia and tracheal intubation, are core skills for doctors who treat seriously ill or potentially ill patients. In the UK, this typically involves the specialties of: anaesthesia emergency medicine intensive care medicine acute medicine. The location for emergency airway management is usually outside the relatively controlled environment of an anaesthetic room, most commonly in the resuscitation room of an emergency department, but sometimes in a variety of other in-hospital and pre-hospital settings. Emergency airway management can be difficult and challenging: it requires individuals to work in relatively unfamiliar environments under conditions of stress and uncertainty, and where the principles of elective anaesthesia need modification. Information is often incomplete, normal physiology deranged, and opportunity for delay is infrequent. The problems intrinsic to these patients, such as an unstable cervical spine, poor cardiorespiratory reserve or profound metabolic dysfunction, must be anticipated and surmounted. Emergency airway management is not simply an extension of elective anaesthesia, and specific training is essential to safely treat this challenging and heterogeneous group of patients. Individuals must practice within the limits of their own competence and work collaboratively with experienced clinicians from several disciplines to ensure patients receive optimal care (Figure 1.1). Skills and judgement, as well as knowledge, are essential for treating patients who require emergency airway intervention. Careful judgement is required to determine whether an intervention is appropriate, how and when it should be undertaken, and what additional personnel and equipment are needed.