Predicting the difficult airway: Difference between revisions
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{{Difficult BVM}} | {{Difficult BVM}} | ||
==Difficult to Intubate (LEMON)== | ==Difficult to Intubate (LEMON)^== | ||
*'''L'''ook externally (gestalt) | *'''L'''ook externally (gestalt) | ||
*'''E'''valuate 3-3-2 rule | *'''E'''valuate 3-3-2 rule | ||
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*'''N'''eck mobility | *'''N'''eck mobility | ||
^An airway assessment score based on criteria of the LEMON method is able to successfully stratify the risk of intubation difficulty in the emergency department.<ref>Reed, M. et al. Can an airway assessment score predict difficulty at intubation in the emergency department? Emerg Med J. 2005 Feb; 22(2): 99–102. doi: 10.1136/emj.2003.008771</ref> | |||
===LOOK=== | ===LOOK=== | ||
Revision as of 07:37, 1 February 2019
Difficult to Bag Ventilate
Difficult BVM (MOANS)
- Mask seal
- Obesity
- Aged
- No teeth
- Stiffness (resistance to ventilation)
Difficult to Intubate (LEMON)^
- Look externally (gestalt)
- Evaluate 3-3-2 rule
- Mallampati
- Obstruction
- Neck mobility
^An airway assessment score based on criteria of the LEMON method is able to successfully stratify the risk of intubation difficulty in the emergency department.[1]
LOOK
- Look at the patient externally for characteristics that are known to cause difficult laryngoscopy, intubation or ventilation[2]
- Trauma
- Short neck
- Micrognathia
- Prior surgery
- May also be difficult to bag
- Body mass index
- Advanced age
- Beard
- No teeth
- Snoring
- Dentures
Evaluate 3-3-2-1
- 3 - Ideally the distance between the patient's incisor teeth should be at least 3 finger breadths
- 3 - Distance between the hyoid bone and the chin should be at least 3 finger breadths
- 2 - Distance between the thyroid notch and the floor of the mouth should be at least 2 finger breadths
- 1 - Lower jaw should not sublux more than 1cm
Mallampati
- The patient sits upright, opens mouth and protrudes tongue
- Grades are based on visibility of the uvula, posterior pharynx, hard, and soft palate
Obstruction
- Assess for conditions leading to airway obstruction such as Peritonsillar Abscess (PTA), trauma, or Epiglottitis.
Neck Mobility
- Patient places chin down onto their chest and extend their neck.
- Remove the hard collar and provide manual stabilization in trauma patients.
- Poor neck mobility impacts ability to have airway access alignment.
See Also
- ↑ Reed, M. et al. Can an airway assessment score predict difficulty at intubation in the emergency department? Emerg Med J. 2005 Feb; 22(2): 99–102. doi: 10.1136/emj.2003.008771
- ↑ Rennie LM, Dunn MJG, et al. Is the ‘LEMON’ method an easily applied emergency airway assessment tool? European Journal of Emergency Medicine 2004;11:154–7