Airway Assessment and Management

Question 1

List the four key scenarios where there might be potential difficulty in securing an airway

Answer 1

Difficulty with bag-mask ventilation
Difficulty with intubation
Difficult rescue of the airway with a supraglottic airway if the above fail
Difficulty with front-of-neck access (FONA) if all three of the above fail

Question 2

How would you predict a difficult mask ventilation?

Answer 2

Using the mnemonic MOANS
M-Mask seal problems (beards, tubes, etc)
O-Obesity or Obstructions
A-Age extremes (elderly or very young)
N-No teeth (edentulous)
S-Stiff lungs or Snoring

Question 3

How would you predict a difficult intubation?

Answer 3

Using the mnemonic LEMON

L-Look externally (does the airway look difficult?
E-Evaluate the 3-3-2:
3 fingers thyromental distance
3 fingers interincisal distance
2 fingers thyrohyoid distance
M-Mallampati classification
O-Obstructions
N-Neck mobility

Question 4

How would you predict a difficult/ impossible supraglottic airway rescue?

Answer 4

Using the mnemonic RODS
R-Restricted mouth opening
O-Obstructions or morbid Obesity
D-Distorted or dysmorphic anatomy
S-Stiff lungs (e.g. bronchospasm)

Question 5

How would you predict a difficult Front of neck access?

Answer 5

Using the mnemonic SHORTY
S-Scars or surgery to the neck
H-Haematomas (bleeding into the neck)
O-Obesity or Obstruction
R-Radiotherapy to the neck
T-Trauma or tumours of the anterior neck
Y-(Very) Young patients

Question 6

What body parts will you look at systematically during a clinical airway examination?

Answer 6

Face, mouth, teeth/dentition, neck (range of motion) and the trachea

Question 7

What would you look out for when looking at the face during an airway assessment?

Answer 7

Overt tumours
Congenital syndromes (Trisomy 21, Pierre-Robin Sequence)
Facial trauma
Facial hair

Question 8

What would you look out for when looking at the mouth during an airway assessment?

Answer 8

Assess the MOUTH OPENING
Look for macroglossia
Look for tumours, trauma, other masses
The MALLAMPATI SCORE is a predictor of difficult intubation
Dentition

Question 9

What would you look out for when looking at the neck during an airway assessment?

Answer 9

C spine injury and exclusion thereof
Length and thickness of neck 
Range of movement 
Thyromental and sternomental distances 
Centrality of trachea

Question 10

What are the 4 D’s of airway assessment?

Answer 10

Disproportion, distortion, dysmobility and dentition.

Question 11

What does disproportion refer to during an airway assessment?

Answer 11

Looking for: 
Macroglossia (big tongue)
Micrognathia (small chin)
High-arched palate
Bony abnormalities
Short thick neck

Question 12

What distortion features are you looking for during an airway assessment?

Answer 12

Airway trauma
Epiglottitis
Laryngeal tumours

Question 13

Dysmobility component of the 4 D’s of airway assessment?

Answer 13

Limited mouth opening
Fixed cervical spine / decreased extension
Cervical spine injury
NEVER examine neck movement if a C-spine injury has not been excluded
Be very careful in trauma patients

Question 14

Dentition component of the 4 D’s of airway assessment?

Answer 14

Is the patient EDENTULOUS? (no teeth)
Are there MISSING TEETH?
Are there PROMINENT TEETH? (e.g. “buck teeth / prominent incisors”
Are there LOOSE TEETH?
Does the patient have specific DENTAL WORK that could be injured with laryngoscopy (e.g. caps, crowns)

Question 15

List the bedside tests that can predict difficult intubation

Answer 15

Distances: thyromental, interincisor, thyrohyoid.
Mallampati classification
Neck mobility

Question 16

What is the name of the score used to predict the ease of intubation?

Answer 16

The Mallampati Score

Question 17

List the 4 classes of the Mallampati Score

Answer 17

Class 1: Complete visualisation of the soft palate
Class 2: Complete visualisation of the uvula.
Class 3: Visualisation of only the base of the uvula
Class 4: Soft palate is not visible at all.