Airway management: thesine qua non of emergency medicine

Abstract

It is our belief that the most important clinical responsibility of our specialty of emergency medicine is the active management of the airway. We certainly utilize all the modern technologies that have been devised for succeeding at this complex and often difficult technical task, but because of the time constraints upon this technical maneuver, and the nature of the profoundly sick patient requiring airway management, there is no way to avoid the “difficult airway”. This is independent of any assessment of the patient’s anatomy as potential or real airway management difficulty. Even when the anatomy is straight forward, and easy to visualize, the absence of which is one of the underlying definitions of a difficult airway, we must often undertake active airway management even in the face of a full stomach, and particularly for the patient who cannot protect the airway because of disease, drug or alcohol. It would be nice if we could tell the patient to return after the stomach has been emptied, and the patient is more able to cooperate without struggle or combativeness, but it is especially true that the confused, struggling, combative patient is the one who most needs active airway management. Starting with this issue of our journal, we will present clinical cases of difficult airway problems, and the best recommended clinical approaches to their management1.