460: Airway Assessment

Question 1

Three mechanisms of injury

Answer 1

1. Esophageal intubation
2. Failure to ventilate
3. Difficult intubation

Question 2

Complications

Answer 2

1. Chipped/ broken teeth
2. Oropharyngeal lacerations
3. Facial trauma
4. Upper airway trauma
5. Ocular trauma
6. Hypoxia
7. Hypercapnia
8. Aspiration
9. Cardiovascular collapse
10. Cardiovascular activation
11. Cerebral insult
12. Edema
13. Hemorrhage
14. Infection
15. Cervical spine injury

Question 3

History and physical consists of…

Answer 3

1. CC - chief complaint
2. HPI - history of present illness
3. PMH - past medical history
4. PSH - past surgical history
5. ROS - review of systems
6. Vital signs
7. PE - physical exam
8. A/P - assessment and plan

Question 4

NPO status

Answer 4

Clear liquids - 2h (incl coffee, apple juice)
Breast milk - 4h
Infant formula - 6h (more fat)
Non-human milk - 6h
Light meal - 6h
Full meal - 8h

Question 5

Dentition numbering system

Answer 5

Adult teeth is numbered from upper right to upper left (1-16) and from bottom left to bottom right (17-32). The most commonly damaged teeth during intubation are 7, 8, 9, 10 and following those, 23, 24, 25, 26.

Question 6

Airway examination –> LEMON

Answer 6

Look
Evaluate
Mallampati score
Obstruction
Neck mobility

Question 7

Look

LEMON

Answer 7

Obesity
Short thick immobile neck
Facial hair
High arched palate
Macroglossia/ large tongue
Neck scars
Cosmetic changes of oral opening
Prominent teeth
Receding mandible
Poor mouth opening
Inability to sublux jaw
Mallampati score
Thyromental distance (6-7cm)
Sternomental distance (12-13cm)

Question 8

Evaluate

LEMON

Answer 8

3: 3:2 rule
- normal mouth opening is 3 patient fingerbreadths
- normal mandibular dimensions is 3 fingers between mentum and hyoid bone
- normal neck dimenision is 2 fingers between hyoid bone and thyroid cartilage

Question 9

Mallampati score

Answer 9

Have patient extend neck, open mouth fully, protrude tongue, and act as if saying “ahhh”

• 1: hard & soft palate, fauces, pillars, entire uvula
• 2: soft palate, fauces, part of uvula
• 3: soft palate and base of uvula
• 4: only hard palate

Question 10

Obstruction

LEMON

Answer 10

Look for foreign bodies in mouth, growths/masses in mouth or neck, tracheal deviation, as well as stridor (high pitched sound due to turbulent airflow in airway)

Question 11

Difficult bag-mask ventilation

Answer 11

Facial hair
Facial deformities
Large head
Obesity (soft tissue of neck collapses during induction of anesthesia)
Large tongue (gets in way of airflow)
OSA - obstructive sleep apnea

Question 12

Nasal trumpet sizing

Answer 12

Equal distance from nares to meatus of ear (opening to auditory canal)

Question 13

Oral airway sizing

Answer 13

Equal distance from mouth to angle of mandible. In most adults, size 8 or 9.

Question 14

ETT sizing

Answer 14

Adults: most males are 7.5-8 while females are 7.0

Pediatrics: 4 + Age/4
- tubes come in half sizes, so found up or down to nearest tube size

Question 15

Risk assessment for intubation

Answer 15

1. Mouth opening less than 4cm
2. Thyromental distance less than 6cm
3. Sternomental distance less than 12.5cm
4. Mallampati scores III and IV
5. Decreased subluxation of mandible