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The Physiologically Difficult Airway

nextgen learning designed to elevate your airway practice


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.” In this space, we will expand your understanding of what makes an airway difficult and show you an effective method for navigating the dangerous physiology of the peri-intubation period so that you can protect your patients from the negative impact that medications, endotracheal tube placement, and positive pressure ventilation can have on critically ill patients. 

Learning Objectives

Learning Spaces are designed to help you master core concepts and essential hands-on procedure skills. Review this list of learning objectives, and then open the User Guide on a separate browser tab to earn points toward completing this learning space on the physiologically difficult airway.

Meet the Director

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, Critical Care Faculty – Director of the Physiologically Difficult Airway Installation

Instructions for Use

Or Skip to Start Course

New to PAC? We design education that merges digital and physical space for better learning. Listen here, and click on the link to learn how to move seamlessly between them to create your path to mastery.

how TO Map Your own Journey

Learn how to use the physical space to get hands-on skills training, expert coaching, and more.

The Online Learning Space

Enhanced Digital Content

Enhanced digital content allows you to learn in two ways. Use the space here as part of the online course for this topic. Then, let the same enhanced digital content guide you through our immersive physical space for hands-on procedure training, skills challenges, and expert coaching. 



Expand your understanding of what makes an airway difficult and learn an effective method for navigating the dangerous physiology of the peri-intubation period.

identify danger

Resuscitate before you intubate! Okay, but how? This is where the rubber meets the road, so let’s start with a cognitive tool to help you predict danger during the peri-intubation period.

adressing hypotension

Peri-intubation hypotension is an independent risk factor for cardiac arrest, longer ICU stays, and in-hospital mortality. Learn how to avoid these risks by protecting your patients from peri-intubation hypotension.

refractory hypoxia

Safe apnea time is the cornerstone of safe airway management. What do you do when critically ill shunt physiology is refractory to your standard preoxygenation efforts? Find out here.

metabolic derangement

Severe acidosis puts your patient at risk of post-intubation cardiac arrest due to the rapid rise of pCO2 during the apneic period. Learn how to mitigate severe metabolic and respiratory acidosis to prevent post-intubation death by hydrogen ions.

supporting the pump

During intubation, diminishing cardiac output can spiral into cardiovascular collapse without the ability to assess the pump and optimize prior to intubation. Learn how here.

The Physical Learning Space

Procedures, Skills, Coaching, Simulations

integrated digital & Physical space

This online learning space has enhanced content designed to be part of an immersive, hands-on training lab. The interactive graphic posters create pop-up learning in the physical space for procedure training, skills challenges, expert coaching, simulations, and team training opportunities.

Guided Practice & Coaching

HANDS-ON training

If you’re in one of our pop-up learning spaces or a PAC Live event, find this icon and use the multimedia tools for hands-on guided practice.

  1. Look for this icon.
  2. Snap the QR code.
  3. Begin your hands-on practice.
  4. Get feedback on your skills.

Don’t forget to ask our faculty coaches for real-time expert feedback and earn points!

Earn Points

Keep yourself on track and get credit for completion using this guide.

  1. Open the guide to a tab on your browser.
  2. Visit each poster & review the content.
  3. Complete any challenges to earn points.


integrated simulations

Turn this learning space into an immersive flipped classroom and test your knowledge in our simulation.

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