This class seeks to inform prehospital providers about the dangers associated with performing airway management procedures on patients who present with physiologic derangements. Using the CRASH mnemonic, participants will learn to identify patients who present with physiologically difficult airways including consumption increases, right ventricular failure, acidosis (metabolic), saturation (risk of desaturation), and hypotension and how to combat these conditions to optimize our patients prior to airway management. Insights from the PREOXI Clinical Trial and other recent landmark studies will be used to inform our discussion of peri-intubation resuscitation and patient optimization. Students will leave this session empowered to tackle the most difficult airways with confidence.