The decision to cut the neck and perform a surgical airway is often delayed. When is it time? There is no number no clear 'go time'. Most agree it's the can't intubate can't oxygenate scenario. Still this represents a spectrum from too early to dead when seconds matter. What is important is to recognize the need to act early and not spend too much time problem solving intermediate steps. Most often good BVM technique or an SGA will work and obviate the need to cut. The mindset however needs to be I'm going to cut but try an SGA first... not I'm going to try an SGA and if that doesn't work I'll move on to cut. The latter feeds in to the avoidance mentality that consumes us when faced with unfamiliar tasks and leads to errors of omission.

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