Despite decades of experience with endotracheal intubation, we continue to find approaches to improving the process of how we intubate.

In today’s post we are not only going to talk about how to avoid post intubation cardiac arrest, but we are also going to cover 5 rather controversial topics in airway management including: Apneic oxygenation (ApOx), use of video laryngoscopy (VL) compared to direct laryngoscopy (DL), bougie 1st intubation, back up head elevated (BUHE) intubation, and finally bag valve mask ventilation (BVM) prior to intubation.

Clinical Bottom Line:

• ApOx in the ED: Just do it. No cost, no cognitive load, and not been shown to be harmful
• VL vs DL: Train in both VL and DL. There is a reason we have multiple tools at our disposal when it comes to airway management.
• Bougie 1st Intubation: Train in both Bougie 1st and standard ETT + Stylet intubation as every airway is unique
• Back Up Head Elevated Intubation: Decreases intubation-related complications in comparison to standard supine intubation
• BVM Prior to Intubation: Consider BVM in patients who do not reach appropriate preoxygenation (>95%) despite the use of non-rebreather and nasal cannula at >15LPM

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