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Situation category

Medical physiology

High-risk physiology before, during, and after the airway.

Severe Asthma / COPD Crash AirwayObstructive physiology is an oxygenation and ventilation problem before it is a tube problem. The dangerous post-tube complications are air trapping, dynamic hyperinflation, hypotension, and dyssynchrony.Flash Pulmonary Edema / SCAPE AirwayMany SCAPE patients improve with rapid NIV, PEEP, and afterload reduction. Intubation may be necessary, but the best airway move is often aggressive noninvasive stabilization first.DKA / Severe Metabolic Acidosis AirwayThe major danger is taking away the patient’s compensatory minute ventilation and then under-ventilating after paralysis.Septic Shock IntubationIn shock, intubation is a hemodynamic procedure. The airway plan and resuscitation plan must run together.RV Failure / Pulmonary Embolism AirwayRV failure airways can arrest with induction, apnea, acidosis, hypoxia, and excessive intrathoracic pressure.Salicylate Toxicity AirwayThe dangerous move is taking away compensatory hyperventilation and then under-ventilating after paralysis. Intubation should be avoided when possible and, if unavoidable, requires a minute-ventilation plan before medications.Status Epilepticus AirwayThe airway supports oxygenation and medication delivery; it does not replace definitive seizure management.Massive Hemoptysis AirwayThe immediate goal is oxygenation while preventing blood from flooding the good lung.Overdose / Aspiration AirwayThe airway decision balances oxygenation, ventilation, aspiration risk, and reversible toxidromes.Anaphylaxis AirwayAirway edema, bronchospasm, and vasodilatory shock can deteriorate simultaneously.
About this resource
Created by: Andrew Pirotte, MD; Kyle Brown, MD; Reba Hodge, MD; Amanda Vanderwerf, PharmD, BCEMP; Morgan Kimball, PharmD, BCEMP; Joshua Mohess Clinical review: Emergency medicine faculty review completed. Medication content reviewed by Amanda Vanderwerf, PharmD, BCEMP, and Morgan Kimball, PharmD, BCEMP. Last reviewed: 2026-07-23 Next scheduled review: 2027-01-23 Designed for: EM residents, emergency physicians, EMS clinicians, airway educators, and simulation faculty Important: Educational resource and cognitive-aid guide only; not a bedside order set or substitute for local protocol, medical direction, or clinical judgment. Website contact: [email protected]