intubation

Question 1

LEMON stands for

Answer 1

• Look externally
• Evaluate 3:3:2 rule
• Mallampati classification
• Obstruction
• Neck

Question 2

What do we look externally for in LEMON?

Answer 2

• Does any physical clue or foreign object portent difficulty?
• Does the neck look big and beefy?
• Is there trauma to the neck?
• Is there trauma to the face, to the mouth—fractures?
• Is there jaw large?
• Is the patient obese?
• Any signs of tumor or mass?

Question 3

What is the 3:3:2 rule in LEMON?

Answer 3

—Can three fingers fit vertically between the teeth?
—Can three fingers fit between the throat and the end of the chin?
— Can two fingers fit between the top of the thyroid cartilage and the hyoid bone?

Question 4

What is the thyromental distance?

Answer 4

The distance between the top of the thyroid cartilage and the hyoid bone.

Question 5

Slog through the Mallampati classification.

Answer 5

Class 1: Hard palate, soft palate, uvula, tonsillar pillars all visible.
Class 2: Hard and soft palate visible, upper portion of tonsils and uvula visible.
Class 3: Hard and soft palate and base of the uvula visible.
Class 4: Only the hard palate visible.

Question 6

Slog through the Cormack-Lehane classification

Answer 6

Grade 1: Entire glottic opening visible
Grade 2: Only portion of glottic opening visible
Grade 3: Only arytenoids or epiglottis visible
Grade 4: Neither glottis nor epiglottis visible

Question 7

What “obstruction” should we look for in LEMON?

Answer 7

• Is anything going to get in the way of intubation?
• Is airway swollen?
• Is airway blocked by vomitus or foreign bodies?
• Could the airway be blocked when the soft tissue of an obese patient relaxes?
• Does any mass impinge on the airway?

Question 8

What features of the neck do we evaluate under LEMON?

Answer 8

• Is the neck mobile?
• Is the neck immobilized by a brace?
• Are there cervical spine fractures or dislocations?