EM SAQs · Front-of-neck access / surgical airway
CICO declaration and scalpel-bougie-tube FONA
ACEM-style SAQ on CICO and FONA technique.
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(a) CICO = cannot intubate AND cannot oxygenate. Declare aloud, stop futile upper-airway perseverance, assign FONA operator, call for senior/surgical help, 100% oxygen, open CICO kit.[1]
(b) Extend neck if safe; laryngeal handshake; transverse scalpel stab through CTM; keep blade/turn 90°; pass bougie caudally (clicks/hold-up); railroad 6.0 cuffed ETT; confirm waveform ETCO2; secure; plan formal tracheostomy later.[1][2]
(c) Needle techniques are not the adult default: scalpel cricothyroidotomy is the recommended rescue technique, and NAP4 shows ED airway rescue fails too often — confirm every tube with waveform ETCO2. Scalpel-bougie-tube is adult Plan D default.[1][2]
References2ShowHide
- [1]Frerk C, Mitchell VS, McNarry AF, et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth, 2015.PMID 26556848
- [2]Cook TM, Woodall N, Harper J, et al. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 2: intensive care and emergency departments. Br J Anaesth, 2011.PMID 21447489