Establishing a patent airway is one of the basic and most important components of basic and advanced life support. However, despite the availability of excellent guidelines/simulation training hypoxic arrests continue to occur in the emergency. This is because, most of the times the child may not be assessed properly in cases of mild to moderate distress at presentation and red flag signs are often missed. Simple measures like pacing a towel or ensuring sniffing position or position of comfort in case of breathing difficulty are not instituted in time eventually leading to a respiratory compromise. Use of appropriate sedatives, analgesics before using muscle relaxants is not ensured, resulting in pain and anxiety in the patient as well as in the care giver as ideal intubating conditions is not achieved in such cases. Use of bag and mask ventilation as a bridging measure in cases of failure of intubation may be life-saving and all health care providers involved in the care of critically ill children, should be skilled in this important procedure if they were to save the life of these patients. In this review, we have once again tried to reemphasize these important principles of airway management in a simple and comprehensive manner. Our emphasis is on simple measures to open the airway, use of airway adjuncts, technique of rapid sequence intubation with a simplified table on drugs commonly used during this important procedure and trouble shooting in an intubated patient. This review is targeted at all fellows in emergency medicine and intensive care and practising paediatricians involved in the care of critically ill/ injured child.

Keywords: Airway; Intubation; Rapid sequence intubation; Bag mask ventilation; RSI; Sedatives; Muscle relaxants; Analgesics.