Personnel

Emergency endotracheal intubation requires more assistance than does an intubation performed under controlled conditions. Three providers are required to ventilate the patient, hold cricoid pressure, and provide in-line cervical stabilization; a fourth provider to administer anesthetic medications allows the intubating physician to maintain an uninterrupted focus on the patient's airway. Figure 63-4 is an illustration of this approach. Additional assistance may be required to restrain a patient who is combative as a result of intoxication or TBI.

The immediate presence of a surgeon or other physician who can expeditiously perform a cricothyroidotomy is desirable. Even if a surgical airway is not required, additional experienced hands may prove useful during difficult intubations. The surgeon may also wish to inspect the upper airway during laryngoscopy if trauma to the face or neck has occurred. Urgent tube thoracostomy may

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Figure 63-4 Emergency intubation of a trauma patient immobilized on a long spine board. The front of the cervical collar is removed once in-line manual stabilization of the spine is established to allow cricoid pressure and greater excursion of the mandible. (From Dutton RP: Spinal cord injury. Int Anesthesiol Clin 40:111, 2002.)