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Airway management: Sometimes tunnel vision is a good thing

Most of us need to depend upon various tools to provide us visual and audible cues as to how well the patient is able to ventilate and exchange gasses.


Airway management is a critical skill. We're taught that in our initial training and reinforce it through ongoing education.

Yet, when evaluating and managing emergent patients, there are so many tasks and procedures to perform that it becomes a challenge to keep a continuous eye on airway matters.

In their words, sometimes tunnel vision is a good thing when managing an airway.

In optimal conditions, a highly experienced provider is dedicated to continuously assessing the patient's airway patency, like the anesthesiologist who has similar responsibilities during a surgical procedure.

Most of us won't have the luxury of having enough sets of hands on scene to have an airway manager. We will need to depend upon various tools to provide us visual and audible cues as to how well the patient is able to ventilate and exchange gasses.

Some of these devices measure gas exchange directly, such as pulse oximeters and continuous waveform capnography.

Personally, I like having the ECG monitor audible beeps turned on low during critical case management. A sudden change in heart rate can provide a subconscious cue to re-evaluate the airway status and determine if increasing hypoxia is the cause.

Ultimately, the best tool we have in airway management is the one between our ears. Make it a point to continuously check on airway patency, and question whether changes in patient condition can be the result of airway loss. Reassess any intervention you perform in airway management, and decide if it's working or if another procedure is needed.

Most importantly, don't ever take airway status for granted. Things can turn at a moment's notice, and you'll want to be prepared when they do.

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