Procedures and Airway Management
This domain tests rapid sequence intubation, failed airway rescue, surgical airway, thoracostomy, vascular access, and procedural safety. The exam expects a clear plan, preoxygenation, and confirmation of tube placement.
Core rules
- Prepare drugs, equipment, suction, and a rescue plan before intubation. Preoxygenate and optimise haemodynamics.
- Confirm tracheal placement with continuous waveform capnography, not auscultation alone.
- In a failed airway, use a supraglottic device or surgical airway according to the cannot-intubate, cannot-oxygenate algorithm.
- Needle thoracostomy is followed by tube thoracostomy; avoid the intercostal neurovascular bundle.
- Provide sedation and analgesia after intubation to prevent awareness and device removal.
Worked example
A head-injured patient needs intubation. Preoxygenate, maintain blood pressure, choose an induction agent that preserves perfusion, and use a neuromuscular blocker. Confirm with capnography and secure the tube.
Traps
- Do not give succinylcholine in hyperkalaemia, burns after 24–48 hours, or denervation injury.
- Do not rely on chest auscultation alone to confirm intubation.
- Do not forget post-intubation sedation.
- Do not attempt a surgical airway without a clear failed-airway indication.