Airway Management
Assessment
Predict difficult airway using the Mallampati score, thyromental distance, mouth opening, neck mobility, and history of previous difficulty. Understand that no single test is reliable and that a combination plus clinical judgment is best. Know the ASA difficult airway algorithm and the concept of the cannot-intubate, cannot-ventilate (CICV) emergency.
Techniques
Know the indications and contraindications for direct laryngoscopy, video laryngoscopy, supraglottic airway devices, and awake fiberoptic intubation. Understand rapid sequence induction and the role of cricoid pressure, and know that cricoid pressure can worsen laryngoscopic view and should be released if it impedes intubation.
Rescue
Know the steps for failed intubation: optimize positioning, use a supraglottic device, consider a second-generation device, and proceed to surgical airway if ventilation fails. Understand the role of the bougie and the Eschmann stylet. Know the anatomy for emergency cricothyrotomy (cricothyroid membrane).
Traps
Questions often ask the next best step after a failed intubation with adequate ventilation; the answer is usually to maintain oxygenation and consider waking the patient or using an alternative technique, not to persist with repeated laryngoscopy. Another trap is the assumption that a Mallampati I airway guarantees easy intubation. Also know that obesity, pregnancy, and a full stomach increase aspiration risk and alter the induction plan.
Worked Example
A patient with predicted difficult airway and a full stomach requires emergency surgery. The safest approach is awake fiberoptic intubation or awake video laryngoscopy with topical anesthesia, preserving spontaneous ventilation, rather than a paralytic induction that risks CICV.