Anaes SAQs · Airway management
Cannot intubate, cannot oxygenate — emergency scalpel-bougie cricothyroidotomy
The surgical-airway SAQ — the declaration of CICO, the six-step scalpel-bougie-tube technique (laryngeal handshake, transverse stab, turn the blade ninety degrees, bougie, railroad a cuffed tube, confirm with capnography), the management of the impalpable obese membrane, and the NAP4-derived rationale for abandoning needle cricothyroidotomy in the adult.
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After induction of anaesthesia in an obese man, intubation fails on three attempts, a second-generation supraglottic airway fails to oxygenate him, and two-person face mask ventilation is impossible. His saturation is falling into the seventies. Outline how you would perform emergency front-of-neck access, and explain why this technique is preferred over needle cricothyroidotomy in the adult.[5]
References5ShowHide
- [1]Ghaffar S, et al. Physiological difficult airway management in the emergency department. JPMA, 2026.PMID 42363338
- [2]Black KM, et al. Anesthesia Care, Complications, and Airway Management for Spinal Muscular Atrophy. Anesth Analg, 2026.PMID 42363899
- [3]Freund Y, et al. Improving the safety of emergency tracheal intubation. Curr Opin Crit Care, 2026.PMID 42170830
- [4]Caputo ND, et al. End Tidal O2: A Promising New Metric for Optimizing Preoxygenation and RSI Safety. Acad Emerg Med, 2026.PMID 42340046
- [5]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.