Physiologically Difficult Airway

In this podcast episode, Dr. Sara Crager discusses the concept of the Physiologically Difficult Airway, emphasizing the importance of making the right decision before intubation. She highlights the need to differentiate between deciding to intubate a patient for a specific reason and knowing how to intubate them safely with various underlying conditions. Sarah suggests that the initial decision to intubate should be carefully considered, with the goal of avoiding intubation when possible. She also discusses the challenges of differentiating between respiratory, hemodynamic, and metabolic issues, which can masquerade as each other, leading to potential mismanagement. Sarah emphasizes the need for a thoughtful and proactive approach to intubation, preparing for potential complications, and addressing underlying physiology.

Key Takeaways:

1. Distinguish between deciding to intubate for a specific reason and knowing how to safely intubate a patient with various underlying conditions.
2. The decision to intubate should be made thoughtfully, with the goal of avoiding intubation when not necessary.
3. Be aware that respiratory, hemodynamic, and metabolic issues can mimic each other, requiring careful differentiation.
4. Proactively anticipate potential physiological challenges during intubation and address them before they become problems.
5. Understand the underlying physiology of acidemia, falling systemic vascular resistance, rising pulmonary vascular resistance, and the effects of positive pressure ventilation when dealing with a physiologically difficult airway.