Predicting the difficult airway: Difference between revisions
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{{Difficult BVM}}
{{Difficult BVM}}


==Difficult to Intubate (LEMON)==
==Difficult to Intubate==
 
A grade 3 on the upper lip bite test (patient unable to bite upper lip with lower teeth) has LR+ 14 for predicting difficult intubation<ref>Detsky ME, Jivraj N, Adhikari NK, et al. Will This Patient Be Difficult to Intubate?: The Rational Clinical Examination Systematic Review. JAMA. 2019;321(5):493-503.</ref>
 
===LEMON===
''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>''
''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====
*Look at the patient externally for characteristics that are known to cause difficult laryngoscopy, intubation or ventilation<ref> 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</ref>
*Look at the patient externally for characteristics that are known to cause difficult laryngoscopy, intubation or ventilation<ref> 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</ref>


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**Dentures
**Dentures


===Evaluate 3-3-2-1===
====Evaluate 3-3-2-1====
[[File:LEMON Score.png|thumb|3-3-2 ruleDistance between patient's incisor teeth of 3 finger breadths and distance between the thyroid notch and the floor of the mouth should be at least 2 finger widths]]
[[File:LEMON Score.png|thumb|3-3-2 ruleDistance between patient's incisor teeth of 3 finger breadths and distance between the thyroid notch and the floor of the mouth should be at least 2 finger widths]]
*3 - Ideally the distance between the patient's incisor teeth should be at least 3 finger breadths
*3 - Ideally the distance between the patient's incisor teeth should be at least 3 finger breadths
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*1 - Lower jaw should not sublux more than 1cm
*1 - Lower jaw should not sublux more than 1cm


===Mallampati===
====Mallampati====
[[File:Mallampati Score.png|thumb|Mallampati Score]]
[[File:Mallampati Score.png|thumb|Mallampati Score]]
*The patient sits upright, opens mouth and protrudes tongue
*The patient sits upright, opens mouth and protrudes tongue
*Grades are based on visibility of the uvula, posterior pharynx, hard, and soft palate
*Grades are based on visibility of the uvula, posterior pharynx, hard, and soft palate


===Obstruction===
====Obstruction====
*Assess for conditions leading to airway obstruction such as [[Peritonsillar Abscess (PTA)]], trauma, or [[Epiglottitis]].
*Assess for conditions leading to airway obstruction such as [[Peritonsillar Abscess (PTA)]], trauma, or [[Epiglottitis]].


===Neck Mobility===
====Neck Mobility====
*Patient places chin down onto their chest and extend their neck.
*Patient places chin down onto their chest and extend their neck.
*Remove the hard collar and provide manual stabilization in trauma patients.
*Remove the hard collar and provide manual stabilization in trauma patients.

Revision as of 23:30, 9 June 2019

Difficult to Bag Ventilate

Difficult BVM (MOANS)

  • Mask seal
  • Obesity
  • Aged
  • No teeth
  • Stiffness (resistance to ventilation)

Difficult to Intubate

A grade 3 on the upper lip bite test (patient unable to bite upper lip with lower teeth) has LR+ 14 for predicting difficult intubation[1]

LEMON

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.[2]

LOOK

  • Look at the patient externally for characteristics that are known to cause difficult laryngoscopy, intubation or ventilation[3]
  • 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

3-3-2 ruleDistance between patient's incisor teeth of 3 finger breadths and distance between the thyroid notch and the floor of the mouth should be at least 2 finger widths
  • 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

Mallampati Score
  • The patient sits upright, opens mouth and protrudes tongue
  • Grades are based on visibility of the uvula, posterior pharynx, hard, and soft palate

Obstruction

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

Airway Pages

References

  1. ↑ Detsky ME, Jivraj N, Adhikari NK, et al. Will This Patient Be Difficult to Intubate?: The Rational Clinical Examination Systematic Review. JAMA. 2019;321(5):493-503.
  2. ↑ 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
  3. ↑ 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
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