Ch 2: Identification of the Difficult and Failed Airway

Question 1

What is CICO

Answer 1

Can’t Intubate & Can’t Oxygenate

Question 2

What is a Failed Airway

Answer 2

1. Failure to oxygenate during/after attempted laryngoscopy.
2. 3 failed attempts by a boss even when O2 OK.
3. 1 best attempt failure in Forced to Act scenario.

Question 3

Forced to Act

Scenario

Answer 3

1. Combative
2. Hypoxic
3. Deteriorating

Must use RSI and if unsucessful move to Failed Airway Management plan.

Question 4

4 Dimensions of “Difficult Airway”

Answer 4

1. Difficult laryngoscopy
2. Difficult BVM
3. Difficult Extraglottic Device (EGD)
4. Difficult cricothyroidotomy

Question 5

L.E.M.O.N

Difficult Laryngoscopy

Answer 5

L. Look externally. Gestalt

E. Evaluate 3 3 2.

3 fingers in mouth

3 tip of jaw to hyoid

2 hyoid to thyroid notch. Too much is bad too

M. Mallampati scale.

1 Tonsil pillars, fauces, Uvula & soft palate

2 Can’t see fauces

3 Only top half of uvula

4 Can’t see uvula

In supine obtunded pt use tongue blade

O. Obstruction/Obesity

Muffled voice, secretions, stridor & dyspnea

Stridor means 50% of airway closed.

N. Neck Mobility

RA and Ankylosing spondylitis trouble

Question 6

R.O.M.A.N.

Difficult Bag Valve Mask

Answer 6

R. Radiation or Restriction

O. OSA and upper airway lesions

M. Mask Seal/Mallampati. Beards etc.

A. Age over 55

N. No teeth

Question 7

R.O.D.S.

Dificult ExtraGlottic Device

Answer 7

R. Restriction. Asthma, pulm edema etc

O. Obstruction/Obesity

D. Disrupted/Distorted airway.

S. Short thyromental distance. Mandible

Question 8

S.M.A.R.T.

Difficult Cricothyroidotomy

Answer 8

S. Surgery

M. Mass

A. Access/Anatomy. Obesity, Halo device etc

R. Radiation

T. Tumor