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Airway management is both a fundamental skill and resuscitative treatment that has taken a prominent role in emergency medicine.  In the past few decades there have been many advancements in airway management particularly in critically ill patients.  Technology has been developed and adapted to provide improved visualization for endotracheal intubation as well as supportive strategies for oxygenation and optimization of medications.  In this review we will discuss the current practices and literature in airway management of critically ill patients including medication optimization and airway visualization techniques for first pass success.