Armamentarium:

• 1-2% lidocaine w/ 1:100,000 epi
• 6-0 cuffed Shiley Trach
• Eschmann Bougie
• Cook Airway Exchange Catheter
• LMA
• Fiberoptic nasopharyngoscope
• ​Molt mouth gag
• D-blade, C-MAC
• Headlights
• Tracheotomy set
• #15 blade
• 2-0 Silk suture x2
• Monopolar electrocautery with guarded tip
• Marking pen

Preop:

• Consent for awake fiberoptic nasal intubation vs awake tracheotomy vs possible emergent tracheotomy
• Lidocaine nasal + throat spray
• Shave bearded patients who may be difficult to mask

OR:

• Place Bovie pad immediately on OR entry
• ​Shoulder Roll
• ​Mark neck for trach prior to sedatives
• Have anesthesia attempt awake nasal fiberoptic intubation without paralysis
• If able to ventilate (bag-mask) but unable to intubate, can re-attempt with Molt mouth prop and oral intubation. Alternatively can prepare for awake tracheotomy
• If unable to ventilate and intubate (or significant bleeding into airway causing desaturation)
• ​​​Insert LMA if possible
• Proceed with emergency tracheotomy

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