[Verse 1]
You walk into the room with a Mallampati score,
Thyromental distance measured, mouth opening four,
But history whispers — prior intubation failed,
So you map the contingencies before the patient's veiled.
ASA and DAS lay the architecture down,
Plan A through D — a scaffold, not a crown.
Awake fiberoptic first when the anatomy's a threat,
Document the difficulty — don't let anyone forget.
[Chorus]
A, B, C, D — four plans before the cut,
Declare the difficulty, never keep it shut,
The Vortex pulls you: mask, supraglottic, blade,
Three lifelines cycling — before the surgical cascade.
Cannot intubate, cannot oxygenate — call it loud,
Cricothyrotomy cuts right through the shroud,
Wake the patient when the margins start to fray,
The algorithm is the anchor, not the getaway.
[Verse 2]
Human factors creep in — fixation, ego, time,
Tunnel vision on the laryngoscope is the silent crime.
Declare it early — "This airway is difficult" —
A spoken word to teammates breaks the occult cult.
The Vortex isn't spiral — it's a three-rung lattice frame,
Face mask, supraglottic, tracheal — cycling through the same.
When all three fail, you've reached the CICO shore,
Scalpel, bougie, tube — the front-of-neck restore.
[Chorus]
A, B, C, D — four plans before the cut,
Declare the difficulty, never keep it shut,
The Vortex pulls you: mask, supraglottic, blade,
Three lifelines cycling — before the surgical cascade.
Cannot intubate, cannot oxygenate — call it loud,
Cricothyrotomy cuts right through the shroud,
Wake the patient when the margins start to fray,
The algorithm is the anchor, not the getaway.
[Verse 3]
Obesity shifts the axes — ramping positions matter,
Obstetrics adds a timeline where the margins shatter.
Pediatric cords sit anterior, epiglottis floppy,
Cervical collar narrows every angle, makes it choppy.
Angioedema swells the supraglottis like a tide,
Thyroidectomy hematoma — decompress or step inside.
Anterior mediastinal mass collapses when supine —
Keep them breathing spontaneously along that precipice line.
Burns and trauma, abscesses, the foreign body lodge —
Each scenario a palimpsest, old dangers underscored.
[Bridge]
There's a word — tmesis — for the split inside a phrase,
We split our plans apart the same, inserting saving grace.
After every difficult encounter, write the letter, file the form,
Register the airway — let the next clinician be forewarned.
A MedicAlert, a registry entry, a discharge note that's clear,
The documentation is the covenant with whoever's next, right here.
[Chorus]
A, B, C, D — four plans before the cut,
Declare the difficulty, never keep it shut,
The Vortex pulls you: mask, supraglottic, blade,
Three lifelines cycling — before the surgical cascade.
Cannot intubate, cannot oxygenate — call it loud,
Cricothyrotomy cuts right through the shroud,
Wake the patient when the margins start to fray,
The algorithm is the anchor, not the getaway.