Airway Assessments Flashcards
Atlanto-Occipital Joint Mobility
- evaluate by having the patient sit with head held erect
- have the patient look up at the ceiling, down at the floor, and then from left to right
- normal extension is 35 degrees
- greater than two-thirds decrease of atlanto-occipital joint extension from a normal of 35 degrees is associated with a grade III to grade IV laryngoscope view
Atlanto-Occipital Joint Mobility Rationale
- assessment of ability to place patient in sniffing position which aligns the oral, pharyngeal, and laryngeal axis (OPL)
- elevation of head by placing a pillow under the occiput and shoulders on table aligns pharyngeal and laryngeal axes
- head extension at atlanto-occipital joint helps to create the shortest distance and most nearly straight line from the incisor teeth to the glottic opening
Temporomandibular Mobility
- how wide can patient open their mouth
- distance between incisors with mouth fully open should be 30-40 mm (2-3 fingerbreaths)
Upper Lip bite test
- have the patient bite their upper lip with their bottom teeth
- assesses the ability to protrude the mandible (jaw will need to move forward with laryngoscopy)
Class 1 upper lip bite
patient able to fully bite their upper lip
Class 2 upper lip bite
patient able to bite only part of their upper lip
Class 3 upper lip bite
patient unable to bite upper lip
Mallampati Classification
- based on assumption that when the base of the tongue is disproportionately large, the tongue overshadows the larynx, resulting in difficult exposure of the larynx during laryngoscopy
- sensitivity = 60-80%
- specificity = 50-80%
MP Class 1
hard palate soft palate tonsillar pillars fauces full uvula
MP Class 2
hard palate soft palate partial uvula fauces *tonsillar pillars not visible*
MP Class 3
hard palate
soft palate
base of uvula
MP Class 4
hard palate only
thyromental distance (Patil’s Test)
- distance form the notch of the thyroid cartilage to the tip of the mentum
- head should be fully extended and mouth closed for evaluation
- distance less than 6cm (~3 fingerbreadths) may indicate difficulty achieving cord visualization for endotracheal intubation
- potential difficulty aligning pharyngeal and laryngeal axis
sternomental distance
- distance between sternal notch and mentum
- exam done with neck fully extended and mouth closed
- sternomental distance less than 13.5cm suggestive of intubation difficulty
dentition
- determine presence of loose teeth, chipped teeth, or removable dental prosthesis
- document preexisting problems
- prominent maxillary incisors or overbite may interfere with achieving optimal laryngoscopic view by displacing the laryngoscope in a more cephalad position
other indicators in airway assessment
- anterior larynx
- prominent upper incisors
- large posterior positioned tongue
- narrow palate (decreases oropharyngeal space for both laryngoscope blade and ETT)
- short neck or thick neck (decreases ability to align the upper airway axes)
- tracheal mobility (observe external neck for abnormalities)
grade I view
full view of glottic opening
grade II view
posterior portion of glottic opening and arytenoid cartilage visible
grade III view
only tip of epiglottis visible
grade IV view
soft palate visible; no recognizable laryngeal structures
