So, if you're unfortunate enough to not
be able to intubate despite the help
and all the little bits of equipment I've mentioned,
remember that what we need to do
more than anything else is maintain oxygenation.
And in some people that it is impossible to intubate,
it's still easy to do that bag and mask technique
and give them oxygen and provide them with
satisfactory oxygenation until you either wake them up,
or you figure out some other way of getting a tube in.
Then, if you have trouble intubating,
you can then utilize one of the airway
adjuvants that you have available. Try to use it. Don't panic.
If you can ventilate the patient by bag and mask,
the patient's going to be fine. As long as they're oxygenated,
they're fine. So don't panic. There's
a tendency to get really frightened in this situation.
Most of us get a real tremor, so that's part of the reason
why you need help. Try twice. The first time
just use your regular technique.
The second time adjust the head position. Make sure
it's optimized. You may want to raise the shoulders a little bit.
You just want to optimize the position.
Put a stylet in the tube. Consider using
one of the adjuvants I've mentioned earlier,
and have another look. You should only
try twice before you move on to a major
adjuvant, such as a video-laryngoscope,
and you should start thinking of whether
you're going to end up going to a surgical airway.