Outline your plan of management for a rapidly deteriorating patient with severe airflow obstruction who is a known difficult intubation.
Initial management should ensure assessment and management of airway, breathing and circulation, as well as level of consciousness. Must be prepared for difficult intubation (essential equipment should be listed, checked and ready; adequate skilled assistance should be present; backup plans are essential). Specific plan should be elucidated with relation to reason for difficult intubation (eg. limited mouth opening, versus high anterior larynx etc.). Main difficulty is that bag-valve-mask ventilation or laryngeal mask ventilation may be impossible. The use of facemask CPAP may provide some time if not contraindicated by deteriorating neurologic state. Bronchoscopic or blind nasal intubation may be reasonable if operator adequately skilled in techniques. Paralysis may otherwise be essential. Early resort to surgical airway may be appropriate if problems develop.
This question is another one of those "how do you manage a difficult airway" questions.
The answer would need to be systematic.
Preparation of the staff
Preparation of the equipment
Specific equipment (the contents of the difficult intubaton trolley)
Preparation of the patient
ANZCA have a statement on the equipment which should be available to manage a difficult airway.
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