AW assessment - Sem 1 Flashcards
What does LEMON stand for ?
L = Look E = Evaluate M = Mallampati O = Obstruction / Obesity N = Neck Mobility
What do you assess in L of LEMON? How do you score it ?
L = Look = Trauma, Large Teeth, Large Tongue, Beard.
Score= 1 pt each, max score for this category is 4
What does E from LEMON stand for ? How do you score it ?
E = Evaluate, 3-3-2refers to :
a) Mouth Opening - 3 Fingers (patient’s fingers), any less than 3 = 1 point
b) Hyoid-Mental Distance (from hyoid to bottom tip of chin), any less than 3 = 1 point
c) Hyoid-Thyroid Distance (space between the hyoid and thyroid, any less than 2 = 1 point
Max score is 3
What does the M in LEMON stand for? How do you score it ?
M = Mallampati Score.
If Grade I or II, that’s good - score 0. If grade III or IV, not good, add 1 point
What does O in LEMON stand for ? How do you score it ?
O = Obstruction (any obstruction, ie vomit, swelling, tumors) add 1 point.
What does N in LEMON stand for ? How do you score it ?
N = Neck Mobility (anything that decreases Neck Mobility add 1 pt)
What is the max LEMON score possible ?
10
Above what LEMON score do we classify it as a “difficult airway” ?
above 3
How does an unconscious patient affect our Airway Assessment ?
Unable to properly do a Mallampati score, as we need the patient to be sitting up and saying “Ahhhhhhh”
If LEMON assesses for ease / difficulty of ETT insertion, what does MOANS assess for ?
Ease / Difficulty of using BVM / Mask Seal
What does MOANS stand for ?
M - mask seal (beard, trauma, facial structure)
O - Obesity / Obstruction
A - Age (>55 yrs)
N - No teeth
S - Stiff Lungs (compliance) - sometime add “C-Spine”
Can you differentiate between compliance and resistance using a BVM ? If so, how? If not, why ?
Unless it’s a fully obstructed Airway, and nothing goes in - - - in which case it’s an obstruction / resistance…..you can’t tell the difference.
Compliance refers to the ease of which the lungs inflate.
All you are going to feel on the BVM is need to apply more or less pressure to ventilate. Unable to tell is that is due to Resistance or Compliance.
How does a BVM PEEP valve work ?
A positive end expiratory pressure (PEEP) valve may be used during BVM to improve oxygenation. PEEP can increase alveolar recruitment and thus oxygenation if oxygenation is compromised even with 100% oxygen due to atelectasis. PEEP has also been shown to prevent lung injury.
PEEP is the pressure above atmospheric pressure measured in the alveoli at end expiration. It is one of the first ventilator parameters set and would typically be “dialed in” to between 3 and 5 cmH2O, sometimes referred to as, “physiologic PEEP.”4 This positive, end expiratory, pressure serves to prevent collapse of the alveoli at end expiration as well as to prevent repeated opening and closing of the alveoli, which is thought to cause ventilator-induced lung injuries. PEEP may also serve to recruit already collapsed alveoli, reopening them so they can participate in gas exchange.5 The primary use of PEEP has typically been to improve oxygenation. PEEP can also be applied when using a bag-valve mask by attaching a PEEP valve to the bag and selecting the level of PEEP desired (see illustration). Some bag-valve-masks are manufactured with integral PE
What is the pneumonic for assessment of airway for insertion difficulty of a SGA?
R - restricted mouth opening
O - Obstruction / Obesity
D - Disrupted / Distorted Airway
S - Stiff Lungs / C-Spine
A 23 yr old healthy patient, with no trauma with regular teeth.
She can fit 3 fingers in her mouth, 2 fingers between her hyoid and chin tip, 2 fingers between hyoid and thyroid
Score the LEMON
L - no trauma, regular teeth, no beard on pic, tongue looks normal - - - so 0
E - Mouth 3+, H-C 2, H-T 2 —– so 1
M - according to photo looks to be class I - – so zero
O - no obstruction or obesity noted - - - so zero
N - no trauma and healthy - expect good mobility, so 0
Total Score : 1
We do not expect this to be a difficult intubation
A patient can fit 2 fingers in mouth, has large teeth and a beard. They have 2 fingers for H-C, 1 finger for H-T. You can only see the hard palet of the mouth on Ahhhh. No obstructions noted. Good neck mobility.
Score LEMON
L = large teeth , beard (no trauma or large tongue noted) - -- score 2 E = 3,2,1 (instead of 3,3,2) - - score 2 M = sounds like a class IV - - -score 1 O = no obstruction / obesity noted - - score 0 N = good neck mobility - - score 0
Total LEMON score = 5
We expect this to be a difficult intubation
What are Ornge’s “Go To” Medications for RSI?
Ketamine for Induction
Rocuronium for NeuroMuscularBlocker (NMB / paralytic)
