Verse 1 – First Assessment Assess respiratory rate, effort in view, Oxygenation tells us what to do. Airway patent or failing to stay? Breathing adequate or slipping away? If yes, we stabilize, hold the line, Spinal motion restriction if it’s time. Altered mental status protocol engaged, While we monitor every stage. Supplemental oxygen if indicated flow, Goal saturation ninety-two or so. Monitor, reassess, don’t lose sight, Exit to protocol when everything’s right. Chorus Airway first—no time to delay, Breathing decides how we proceed today. Support ventilation, maintain the air, Every second matters—we’re already there. From oxygen mask to advanced airway care, We adapt, we act, we prepare. Verse 2 – When Airway Fails If obstruction blocks the patient’s breath, We move with urgency, nothing left. Breathing support needed—then we begin, Orotracheal intubation enters in. Direct or video laryngoscopy try, But recognize when attempts run dry. One attempt defined as blade through teeth, Then adjust approach beneath. Failed airway criteria come into play: Can’t ventilate or oxygenate, no way, Three failed attempts or anatomy wrong, We shift to failed airway protocol strong. Exit to adult failed airway plan, We change the route, adapt as we can. Pre-Chorus – Anticipate the Difficult Airway ROMAN for BVM struggle we see: Radiation, obesity, OB pregnancy. Mask seal issues, age over fifty-five, No teeth—harder to keep them alive. RODS for BIAD complexity rise: Obstruction or distorted airway size. LEON for laryngoscopy difficulty call: External anatomy may block it all. SMART for surgical airway risk ahead: Scars, masses, radiation spread. We plan before crisis fully ignites, Anticipation guides our fights. Chorus Airway first—no time to delay, Breathing decides how we proceed today. If BVM works and sats stay high, We maintain basic support nearby. Ten to twelve breaths per minute we give, EtCO₂ control helps them live. Verse 3 – Escalation Pathway If oxygen drops or ventilation fails, We escalate through structured trails. Airway obstruction foreign body seen, We intervene with focused routine. Tracheostomy complications arise, We follow protocol, stabilize. Chest decompression if indicated shows, When pneumothorax risk grows. NIPPV considered when useful aid, Bi-level support carefully made. BIAD airway if intubation fails, We shift strategies along established trails. Post-intubation care begins its phase, Tube secured through all transfers and stays. Gastric tube placement if time allows, To reduce complications and gastric plows. Bridge – DOPE Check Displaced tube, obstruction found, Pneumothorax or equipment sound. Failure of gear—we reassess, DOPE rules guide us through distress. If oxygenation stays above ninety-two, BVM alone may carry them through. Basic airway measures can still remain, If stability stays in the frame. Verse 4 – Final Control Difficulty cricothyrotomy we assess, Surgery, scars, or masses press. Access problems or anatomy tight, Radiation injury alters the site. We don’t rush blindly into the skin, We choose the safest way to win. Every airway step is measured, precise, Built on training, protocol, and device. Final Chorus Airway first—that’s always the rule, Breathing decides what tools we use. From oxygen mask to surgical line, We adapt in real time. When ventilation holds, we stabilize care, When it fails—we’re already there. Outro Secure the tube, stabilize tight, Through movement, transfer, day or night. From first assessment to final control, We manage airway as our role. Calm in chaos, trained and aware— We keep them breathing through every scare.
