A difficult Airway

This video was sent to me from a friend with a question about how would I manage this poor kid’s airway. A firecracker exploded in his mouth and obviously caused a lot of damage. Airway is a major concern here but how do you manage it?

Rapid sequence intubation? Paralyzing the kid means you HAVE to get the tube in and that may not happen due to distorted anatomy.

Cricothyroidotomy? Probably what I would do first…it also has the advantage of allow the patient to stay awake.

Nasal intubation? Cribiform plate fracture? Are you going to intubate the brain?

I know some pretty clever providers read this blog, what do you think?

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