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The Physiologically Difficult Airway


Resuscitate Before You Intubate


There’s a dangerous intersection between critically ill physiology and intubation. If you don’t want to crash and burn, you must pay attention to the number one rule of the road “resuscitate before you intubate.” To do that you will have to expand your concept of the difficult airway into the physiologic space so that you can protect your patients from harm. We show you how here.

Learn the 4p’s of peri-intubation resuscitation in this masterclass with Sara Murphy

If “resuscitate before you intubate” is the meme of the physiologically difficult airway, then the four P’s of peri-intubation resuscitation are its organizing principle.

— Sara Murphy DO – Director of the Physiologically Difficult Airway Installation

Map Your own Journey

These learning spaces are self-directed. Use this masterclass format here as a stand alone online course, or as a supercharged flipped classroom to maximize your in person training time for one of our immersive in person installations

What’s in this space

  • An enhanced understanding of the physiological consequences of intubation & PPV
  • A cognitive tool for peri-intubation care
  • Expert tips for real world implementation
  • Critical resuscitation procedure skills
  • Expert discussions
  • Masterclass style learning
    • Online digital training
  • Self-practice learning tools 🤔
    • Guided audio
    • Microskills
  • Integrated in person learning.✋
    • Expert coaching
    • Simulation challenges
  • Curated FOAMed content
  • Learning network building
approximate time required: 90min
instructions for use

Where to start

Resuscitate before you intubate! Okay… but how? Here is where the rubber meets the road 🛣

pressure – focus on hypotension

1 Peri-intubation hypotension is an Independent Risk Factor for cardiac arrest, longer ICU stays, and in-hospital mortality. Vasodilation, loss of intrinsic sympathetic surge, and increased intrathoracic pressure from positive pressure ventilation are all potential hazards of intubation. Learn how to avoid these risks and protect your patients from peri-intubation hypotension

preox – Focus On Hypoxia

2 Safe apnea time is a cornerstone of safe airway management, but the rate at which oxygen is consumed increases substantially in the critically ill, and shunt physiology means you need more advanced pre-oxygenation techniques to provide a safe level of oxygenation prior to intubation.

ph – Focus On acidemia

3 Severe acidosis, puts the patient at risk of postintubation cardiac arrest due to the rapid rise of pCO2 during the apneic period. This station will cover the basics of both metabolic and respiratory acidosis and give you a strategy to prevent post-intubation cardiac arrest and death by hydrogen ion.

the PUMP – Focus On rv failure

4 During intubation,  positive pressure ventilation rapidly increases the RV’s afterload while simultaneously decreasing the preload. This leads to decreased LV filling, decreased cardiac output, and eventually, cardiovascular collapse.  This section of the installation will teach you how to assess and mitigate the risks of RV dysfunction.





anatomy lab
Build Your Own Learning Installations with the PAC Poster Series

The PAC posters used in the course are available to you, so you can build these essential emergency airway installations at your shop. Just download and print our interactive posters, and you will have access to all the embedded digital airway content that will walk learners through all the core concepts and skills for this topic. Set them up in any pop up spac, then keep them up as long as you like, use them over and over! Just add your own equipment and faculty for hands on learning.

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