Manage a child with a difficult airway in the emergency department — OSCE

OSCE management station: anticipating and preparing for an anticipated-difficult paediatric airway, delivering the recognise-oxygenate-escalate-rescue sequence, recognising deterioration, rescuing with the supraglottic airway, and preparing for the rare cannot-intubate-cannot-oxygenate event.

acute management and escalation station2 min readVerification in progress

Prompt

A 3-year-old girl with Goldenhar syndrome and a documented previous difficult intubation is brought to the emergency department with increased work of breathing, stertor and decreasing saturations after a viral illness. She is tripoding and distressed but maintaining her airway awake. The team plans to intubate. You are the paediatric registrar asked to assess the airway and outline the management plan.

Candidate brief

You have this station to assess an anticipated-difficult airway, prepare the team and equipment, and outline the recognise-oxygenate-escalate-rescue plan including how you would respond to failure. Identify this as an anticipated-difficult airway, assemble the right help and rescue equipment, and never let it become a cannot-oxygenate airway. [2] [1]

Paediatrics Fellowship Pro

You have read the opening of this case. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References4Show ledger

[1]Black AE, Flynn PE, Smith HL, et al. Development of a guideline for the management of the unanticipated difficult airway in pediatric practice. Paediatr Anaesth, 2015.PMID 25684039
[2]Engelhardt T, Weiss M. A child with a difficult airway: what do I do next? Curr Opin Anaesthesiol, 2012.PMID 22499162
[3]Disma N, Virag K, Riva T, et al. Difficult tracheal intubation in neonates and infants. NEonate and Children audiT of Anaesthesia pRactice IN Europe (NECTARINE): a prospective European multicentre observational study. Br J Anaesth, 2021.PMID 33812665
[4]Park R, Peyton JM, Fiadjoe JE, et al. The efficacy of GlideScope videolaryngoscopy compared with direct laryngoscopy in children who are difficult to intubate: an analysis from the paediatric difficult intubation registry. Br J Anaesth, 2017.PMID 29028952