Field notes: One of the toughest airways of my career.

Technique matters. Thinking matters more.

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Earlier this year, I cared for a critically ill patient in the ER. He was essentially unconscious. He needed intensive care, which we initiated. He needed a breathing tube—that is, I was going to have to temporarily paralyze him, prop open his mouth, and place a plastic tube down into his trachea, which we would then connect to a ventilation machine to breathe for him.

My initial assessment was that intubating him would be routine. There’s no such thing as an “easy airway,” but there were no red flags screaming that this would be unusually difficult.

And yet…