(ED: Any ER physician will tell you one of the most stressful moments in their entire lives is facing someone who is diffcult to “tube”; eveyone is watching, and it is a critical step, so any tool, like this app, that makes an algorithm-like approach is useful to the max)


Purpose of App Review

  • How well does this medical app teach clinicians to manage difficult emergent airways?
  • How useful is the clinical information provided as a bedside reference for managing difficult airways?


We Emergency Physicians fancy ourselves the Macgyvers of medicine, able to creatively solve almost any emergent problem that we come across. Still, there are a few situations which most of us would probably admit we still find a bit terrifying, because no matter how hard we prepare for them, things could still go very, very wrong.

One of those formidable clinical situations is difficult airway management.

Airway management is a challenging skill set, especially in an emergent environment. Failure to successfully establish an airway can lead to patient death or other serious outcomes. Those clinicians who manage airways in an emergent setting must always be prepared for difficult cases, and must master a variety of airway management skills.

The Difficult Airway App is a medical app for iOS that addresses this clinical obstacle head on. It was created by the physicians behind the Difficult Airway Course™ – Ron M. Walls, MD, Michael F. Murphy, MD and Robert C. Luten, MD.

User Interface

Contents is organized in an easy to navigate main menu.


Predicting The Difficult Airway reviews the main mnemonics that describe airway evaluation techniques. This is supplemented by a fifteen minute video in the Educational Resources Section that reviews each technique in detail.


Airway Algorithms review the actions and decision making steps for managing a crash airway, difficult airway, and failed airway. The algorithms are the same as those in theAirway chapter of Rosen’s Emergency Medicine, which was also written by Dr. Walls. (1)


Succinylcholine is a commonly used neuromuscular block agent used in Rapid Sequence Intubation (RSI) that may uncommonly cause dangerous hyperkalemia. The section on SCh Hyperkalemia lists contraindications to using succinylcholine and outlines treatment strategies for hyperkalemia.


The RSI calculator will calculate weight based dosing for commonly used Adult and Pediatric RSI drugs after the user inputs weight, body habitus, qualitative blood pressure, and indications for premedication. Calculations indicate whether the ideal body weight, adjusted body weight, or lean body weight is used for dosing. Strangely, the mg/kg dose calculation is not shown.


The user can edit this list to exclude uncommon agents. An info button next to each drug will pull up helpful information about the agent.


The pediatric drug calculator is formatted using Broselow length and weight based color coding, and includes calculations for drugs, equipment, and ventilation settings.


The educational resources section contains well made videos about predicting the Difficult Airway, using Video Laryngoscopy, and performing a Surgical Airway. Helpful illustrations show airway anatomy.



  • $2.99


  • Evidence based education on airway management
  • Information presented in both short diagrams for bedside reference and longer videos for self study
  • Focused on high yield information


  • Does not include exact mg/kg dosing calculation used in drug calculator
  • Not optimized for iPhone 5

Healthcare providers that would benefit from the app

  • Clinicians that manage emergent airways


  • This comprehensive app created by physician leaders in the world of airway management is a tremendously useful tool for both personal study and bedside reference  and calculations. This app is not available on the Android platform.

iMedicalApps recommended?

  • Yes

iTunes Link
Developer Website

Type of Device used to review app: iPhone 4S running iOS 6.1
Version of App: 1.5

Rating: 4.75 / 5 Stars
User Interface -­ 4 -­ Simple to navigate. Not yet optimized for iPhone 5.
Multimedia usage ­- 5 -­ Helpful diagrams and videos.
Price ­- 5 ­- $2.99 is reasonable for a medical app.
Real world applicability -­ 5 -­ Tremendously useful for those learning to manage difficult airways and those looking for a pocket reference on airway management.

1. Walls RM. “Airway.” In: Marx JA, Hockberger RS, Walls RM, et al., eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. Philadelphia, PA: Mosby/Elsevier; 2010: 3­22.


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