Physical Examination (O/E) + Airway Assessment Flashcards
What baseline vital signs do you need to examine?
- Blood pressure (BP) 🡪 controlled or not, newly diagnosed HTN, etc (may require optimisation before surgery)
- Nutritional status, fluid balance, temperature, condition of skin and mucous membranes
What aspects of the airway do you need to evaluate?
- Length of upper incisors
- Condition of dentition
- Relationship of maxillary incisors to mandibular incisors
- Ability to protrude or advance mandibular incisors in front of maxillary incisors. Inter-incisor or inter-gum (if edentulous) distance: (should be at least 2 FB (~ 3 cm), place finger at side of mouth to check)
- Tongue size
- Visibility of uvula
- Presence of heavy facial hair
- Compliance of the mandibular space
- Thyromental distance with head in maximum extension: Thyromental distance (good if at least 3 FB (6-7 cm); concern if < 6 cm) = distance from tip of thyroid cartilage to tip of chin (mentum)
- Length of neck
- Thickness or circumference of neck
- Range of motion of head and neck
- Grossly visible external features (contributing to difficult mask ventilation or intubation), e.g. facial trauma, large incisors, beard/moustache, large tongue, neck masses, tracheal deviation, or if patient is edentulous
What are the cardiovascular features you need to take note of?
- Rate, rhythm, peripheral pulses, carotid bruit, murmurs, arterial pressure, dependent oedema
- Anaesthetic drugs are cardiovascular depressors and vasodilators 🡪 be careful; BP will crash if not well-resuscitated
What are the respiratory features you need to take note of?
Central vs peripheral cyanosis, dyspnoea, wheezing, rhonchi, stridor (inspiratory vs expiratory), baseline pulse oximetry saturation (SaO2)
What are the gastrointestinal features you need to take note of?
Ascites, abdominal distension, guarding
What are the musculoskeletal features you need to take note of?
Neck range of motion, scoliosis, pectus excavatum/carinatum
What are the neurologic features you need to take note of?
Baseline muscle strength (UL, LL), mental status, any pre-existing nerve injury (to special senses, to spinal peripheral motor/sensory, to cranial nerves)
What is the mallampati score?
- Class 1: complete visualisation of soft palate, fauces, uvula, tonsillar pillars
- Class 2: soft palate and upper portion of uvula
- Class 3: visualisation of only the base of uvula
- Class 4: soft palate is not visible at all; only hard palate is
Class 1 and 2 🡪 intubation easy. Class 3 and 4 🡪 intubation difficult; may require additional equipment (anticipate a difficult airway)
What investigations are commonly ordered?
Bloods: FBC, U/E/Cr, PT/APTT, hypocount (sugar/glucose)
ECG
- For all age > 40, to assess cardiac status
- For those with HTN, DM
CXR
What is ASA PS Class 1?
- Normal healthy patient
- No organic, physiologic, biochemical, or psychiatric disturbance
What is ASA PS class 2?
Mild-to-moderate systemic disease that is well-controlled, and causes no organ dysfunction or functional limitation, e.g. treated hypertension, DM (without renal impairment, etc)
What is ASA PS class 3?
Severe systemic disease of at least 1 organ system that does cause functional limitation, e.g. stable angina, IHD, previous stroke
What is ASA PS class 4?
Severe systemic end-stage disease of at least 1 organ system that is life-threatening with or without surgery, e.g. congestive heart failure or renal failure (ESRF)
What is ASA PS class 5?
Moribund patient who has little chance of survival but is submitted to surgery as a last resort (resuscitative effort), e.g. ruptured aortic aneurysm (AAA)
What is ASA PS class 6?
A declared brain-dead patient whose organs are being removed for donor purposes
