Airway emergencies: recognition and the structured response

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Target exams

Red flags

• A falling saturation with failing ventilation or obstruction is an airway emergency until proven otherwise — the margin to hypoxic cardiac arrest is measured in minutes.
• Hypoxic bradycardia in an airway crisis signals imminent arrest; the treatment is oxygenation by whatever means, not an antiarrhythmic — atropine alone does not prevent arrest from ongoing hypoxia.
• Inspiratory stridor, tracheal tug and recession indicate partial obstruction that may become complete; preserve spontaneous ventilation and call for senior help.
• Failure of mask ventilation AND a supraglottic airway is cannot-intubate-cannot-oxygenate until the airway is recovered — declare it and move to front-of-neck access without delay.
• Repeated laryngoscopy attempts during a crisis worsen bleeding, oedema and physiological decompensation; cap attempts and escalate.
• Unrecognised oesophageal intubation is fatal — confirm every tube placement with waveform capnography, especially in the emergency.