title: Awake Laryngoscopy in the Emergency Department.
abstract: BACKGROUND
  Many emergency physicians gain familiarity with the laryngeal anatomy only during the brief view achieved during rapid sequence induction and intubation. Awake laryngoscopy in the emergency department (ED) is an important and clinically underutilized procedure.
  
  
  CONCLUSIONS
  Providing benefit to the emergency physician through a slow, controlled, and deliberate examination of the airway, awake laryngoscopy facilitates confidence in the high-risk airway and eases the evolution to intubation, should it be required. Emergency physicians possess all the tools and skills required to effectively perform this procedure, through either the flexible endoscopic or rigid approaches. The procedure can be conducted utilizing local anesthesia with or without mild sedation, such that patients protect their airway.
  
  
  CONCLUSIONS
  We discuss two clinical scenarios, indications/contraindications, patient selection, and steps to performing two approaches to awake laryngoscopy in the ED.
authors.affiliation: Division of Cardiothoracic Surgery & Division of Emergency Medicine, Department of Surgery, University of Utah School of Medicine, Salt Lake City, Utah.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Tonna
authors.affiliation: Section of Emergency Medicine; Section of Pulmonary and Critical Care, Department of Medicine, Louisiana State University School of Medicine, New Orleans, Louisiana.
authors.forename: Peter M C
authors.initials: PM
authors.lastname: DeBlieux
mesh_terms: D000287:Administration, Topical; D000368:Aged; D058109:Airway Management / Q000379:methods; D000700:Analgesics / Q000494:pharmacology / Q000627:therapeutic use; D000758:Anesthesia / Q000379:methods; D003243:Consciousness / Q000145:classification*; D000075202:Contraindications; D020927:Dexmedetomidine / Q000494:pharmacology / Q000627:therapeutic use; D004636:Emergency Service, Hospital / Q000458:organization & administration; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology / Q000627:therapeutic use; D007442:Intubation, Intratracheal / Q000295:instrumentation / Q000379:methods; D007649:Ketamine / Q000494:pharmacology / Q000627:therapeutic use; D007828:Laryngoscopy / Q000295:instrumentation / Q000379:methods*; D008012:Lidocaine / Q000494:pharmacology / Q000627:therapeutic use; D008874:Midazolam / Q000494:pharmacology / Q000627:therapeutic use; D008875:Middle Aged
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D020927:Dexmedetomidine; D007649:Ketamine; D008012:Lidocaine; D008874:Midazolam
keywords: airway management; awake intubation; awake look; laryngoscopy