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Book Review |
Toronto, Ontario
A textbook on airway management, specifically intended for Emergency physicians is desperately needed, since, as the book's Editor-in-Chief writes "Airway management defines the specialty of emergency medicine...and [it is] often the emergency physician alone, who is...ready to respond immediately to a life-threatening airway crisis." I confess—it was difficult to remain dispassionate about this book after such an affront to otolaryngologists and anesthesiologists.
This book is a companion to the National Emergency Airway Management course, developed and administered by its authors. The course, like their book, provides an algorithmic approach to emergency airway management and, while the book contains helpful illustrations and tables and provides a number of useful mnemonics, the complexity of the algorithms is staggering and unmanageable.
They identify a number of generic settings including the "crash airway", the "difficult airway" and the "failed airway". But the cornerstone for emergency airway management is the "rapid sequence intubation". This is not surprising given that virtually all Emergency Department (ED) patients have full stomachs, but Walls states that there "are no absolute contraindications [to rapid sequence intubation]. Difficult intubation per se is not a contraindication to RSI..." In support of this statement, they invoke an abstract from the National Emergency Airway Registry describing a 99% success rate in 4000 ED RSI intubations.
The recommended management of the "failed airway" is simple: if the oxygen saturation is greater than 90%, techniques such as the intubating laryngeal mask, the Combitube, lightwand and fibreoptic intubation can be considered; if the saturation is less than 90% a surgical airway is recommended. I would recommend that additional attention be paid to the training of direct laryngoscopy. Unfortunately, this is described superficially and an unconventional technique (intended for use a straight blade) is recommended for all laryngoscopes, without any evidence to support its efficacy.
While this book may meet the needs of the Emergency Room physician, I was frustrated by unsupported, contentious statements, excessively complex algorithms and insufficient attention to direct laryngoscopy and adjunctive techniques.
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