Often when we think of the airway, we consider the entire respiratory system, forgetting that the upper and lower airway structures have different anatomies and, thus, are affected by different respiratory issues.

On January 2, people around the nation — be they football fans or not — were stunned by the live images from the Monday night football game, as the Buffalo Bills’ Damar Hamlin collapsed seconds after a tackle. Trainers soon began performing CPR, as it was later revealed the young player’s heart stopped twice on the field and he could not breathe without medical assistance.

Airway management is a necessary intervention in many patient emergencies — from airway compromise to respiratory failure and cardiac arrest. However, depending on how severe the patient’s condition is, and the invasiveness of the intervention, airway management often causes negative effects to patients’ mental and physical health. 

Drug overdoses, sudden injuries, respiratory issues, and myriad other health concerns can trigger cardiac arrest. Cardiac arrest is a leading cause of death, but many of these deaths are preventable. Every year, more than 383,000 cardiac arrests occur outside of hospitals. Bystanders providing CPR immediately can double or triple the chance of survival. The figure is even higher when trained first responders are prepared to perform CPR while managing the airway. Airway management is key to successful CPR, and first responders must have the right equipment ready to go. 

Before the fall of 2022, most people were not thinking much about respiratory syncytial virus (RSV), even though most children get the illness by age 2, and even adults get the disease. But a remarkable surge of RSV cases, coupled with a heavy flu season and ongoing COVID-19 infections, is creating a trifecta of respiratory diseases that is wreaking havoc and pushing hospitals to the limit, and EMTs are seeing an uptick in calls concerning those facing serious symptoms.

Aspiration of pharyngeal or gastric material into the lungs is a significant risk for many patients in the ICU. This may lead to the development of aspiration pneumonia, which can cause serious complications.

Seizures are a common emergency. First responders frequently encounter febrile seizures in children, epileptic seizures, and seizures due to brain anomalies such as dementia or brain lesions. In most cases, the seizure itself is not dangerous, but the medical condition that caused it may be.

Precision and skill is required for Advanced airway management, especially in vulnerable patients. When performed correctly, initiating nasopharyngeal airways is very safe—and much safer than the alternative of doing nothing. Many first responders are reluctant to initiate a nasopharyngeal airway, citing fears of complications. But this route can enable intubation in patients with an intact gag reflex. Proper training can promote greater confidence, so don’t let fear deter you from practicing this life-saving technique. Forewarned is forearmed, so let’s look at some potential complications. 

Have you ever been in a code situation where there were multiple failed intubation attempts on a patient? If so, you aren’t likely to forget it. Managing a difficult airway is one of the most challenging circumstances for even the most seasoned medical professional.