Initial question set
At bedside, airway reasoning starts with three immediate questions:
- Is the airway currently patent?
- Is oxygenation adequate and stable?
- Is ventilation adequate and stable?
Then add trajectory: is the patient improving, static, or deteriorating over minutes?
High-value exam signals
- Speech: inability to complete phrases suggests significant respiratory compromise.
- Sound: stridor suggests upper-airway narrowing; expiratory wheeze suggests lower-airway narrowing.
- Work of breathing: accessory muscle use, retractions, or paradoxical breathing increases concern.
- Mental status: agitation, somnolence, or confusion in respiratory distress is a danger sign.
- Secretions and emesis: raise aspiration risk and procedural complexity.
Monitoring logic
Pulse oximetry tracks oxygen saturation, not ventilation quality. Capnography can add direct trend information for ventilation and is important when confirming advanced airway placement.
Difficult-airway anticipation
Before definitive airway attempts, evaluate whether bag-mask ventilation, supraglottic airway rescue, and intubation are likely to be straightforward or difficult. Modern difficult-airway practice emphasizes having backup plans declared before first attempt.
Clinical reasoning pattern
- Localize likely site: upper airway, lower airway, or mixed process.
- Estimate time pressure: immediate rescue, urgent stabilization, or monitored progression.
- Match intervention to physiology: improve airflow, oxygen delivery, ventilation, or all three.
For guideline-level frameworks, see References and guidelines.