Prehospital care providers must make split-second decisions daily, often with profound implications on the patient’s outcome.  However, as the adage goes, “the patient doesn’t read the protocols” often holds true, and providers are faced with making decisions for out-of-the-ordinary situations.  These situations often will rely on a provider’s understanding of pathophysiology and critical thinking to manage complex situations.  This class will focus on four cases in which airway management was complicated by complex physiology and learning points attendees can take away for their practice.