Airway Flashcards
What is a class 0 on the modified mallampati score?
any part of the epiglottis is visible
What is a class 1 on the modified mallampati score?
soft palate, uvula and pillars completely visible
What is a class 2 on the modified mallampati score?
soft palate and uvula are completely visible, pillars are not
What is a class 3 on the modified mallampati score?
soft palate and base of uvula are visible
What is a class 4 on the modified mallampati score?
only hard palate is visible
What is a grade 1 view on the Cormack-Lehane scale?
entire laryngeal aperture is visible
What is a grade 2 view on the Cormack-Lehane scale?
grade 2 means only the posterior largneal aperture is visible. Divided into 2 subclasses. 2a means only part of the vocal cords are visible, 2b means only the aryntenoids or very posterior origin of the cords are visible.
What is a grade 3 view on the Cormack-Lehane scale?
only the epiglottis is visible
What is a grade 4 view on the Cormack-Lehane scale?
only the soft palate is visible
What is the evidence regarding DL vs VL?
The NEAR investigators studie 11700+ ED intubations (many performed by residents) and compared VL and DL on a variety of different items. VL has higher first-attempt success rate (91% vs 81%) despite more challenging patient characteristics (mouth opening, neck immobility). Adjusting for confounders, odds of success were 2.8x higher for first pass success. (Brown et al 2020)
Similarly, a cochrane review (2022) studied 222 studies across 26,0000 + showed moderate-certainty evidence that a Macintosh-style VL probably reduces rates of failed intubation (risk ratio (RR) 0.41). in patients with predicted, known, or simulated difficult airways, VL reduced the rate of failed intubation as compared with direct laryngoscopy (DL) (4.5 versus 10.2 percent, relative risk [RR] 0.32, 95% CI 0.23-0.44).
What is the acronym LEMON. What population/technique is it studied best for?
An acronym for a physical exam assessment for difficult airway.
L - general impressions, abnormal facies, asymmetry, trauma, habitus
E - 3/2/2 rule
M - Mallampati score
O - obstruction/obesity
N - Neck mobility
Studied primarily DL intubation. Usually LEMON negative = NPV 98% (in one Japanese study)
What test was designed to evaluate for difficult VL?
upper lip bite test - If the patient can fully cover their upper lip with their lower incisors, difficult laryngoscopy is unlikely. (studied in review from over 18000 patients but questionable journal)
What is the 3-3-2 rule?
3 - patient can fit 3 fingers (stacked) in their mouth
3 - patient can fit 3 fingers between mentum and neck/mandible junction
2 - patient can fit 2 fingers between thyroid cartilage and mandible/junction
What is the acronym ROMAN?
predictors for difficulty BMV
R - radiation (head and neck radiation)
R - restriction
O - obesity/obstruction/OSA
M - mask seal (normal anatomy, beard,
M - male
M - mallampati score
A - Age > 55
N - no teeth
