Manual in-line immobilization of the neck makes tracheal intubation difficult: 20% of trauma patients have a grade 3 laryngoscopy.

Use a gum-elastic bougie. Consider using a McCoy laryngoscope or videolaryngoscope if available. Remove cricoid pressure and use external laryngeal manipulation if necessary.

Always maintain oxygenation: ventilate with a bag-valve mask and guedel airway between intubation attempts.

If you cannot intubate and ventilation is difficult, try a supraglottic airway, e.g. laryngeal mask or Igel airway. This is not a definitive airway.

If you cannot intubate and cannot ventilate, a surgical cricothryoidotomy will be necessary.

Please refer to e-SAFE e-learning session 03_13 Simple Management of Difficult Intubation for further information.