The Difficult Airway

Question 1

Difficult Extraglottic Device Pneumoic

Answer 1

RODS

Question 2

Difficult Cricothyrotomy Pneumoic

Answer 2

SHORT

Question 3

Difficult Laryngoscopy and Intubation Pneumonic

Answer 3

LEMON

Question 4

Difficult BVM Pneumonic

Answer 4

MOANS

Question 5

RODS - Breakdown

Answer 5

R estricted mouth opening
O bstruction
D isrupted or D istorted airway
S tiff lung or cervical Spine

Question 6

SHORT - Breakdown

Answer 6

S urgery or other airway obstruction
H ematoma (includes infection/abscess)
O besity
R adiation distortion (and other deformity)
T umor

Question 7

LEMON - Breakdown

Answer 7

Look externally-
Use your clinical gestalt, evidence of lower facial disruption, bleeding, smallmouth, agitated patient
Evaluate-
Use the 3-3-2 rule: mouth open, mandible, glottis
Mallampati score -
In order of increasing difficulty Class I-IV
Obstruction / Obesity -
There are Four cardinal signs of upper airway obstruction: stridor, muffled voice, difficulty swallowing secretions, and sensation of dyspnea. Obese patients frequently have poor glottic views.
Neck mobility -
May not be able to optimally move the head and neck due to trauma, arthritis, ankylosing spondylitis. Immobilize the neck and consider using video laryngoscopy.

Question 8

MOANS - Breakdown

Answer 8

Mask seal-
Bushy beards, crusted blood on the face, or disruption of lower facial continuity
**Obesity / Obstruction- **
Obesity, pregnancy, angioedema, Ludwig’s angina, upper airway abscess, epiglottitis
Age Age > 55
No teeth-
May leave denture in edentulous patients.
Sleep apnea / Stiff lungs-
COPD, asthma, ARDS, others

Question 9

Mallampati - Breakdown

Answer 9

Class I: Full visibility of tonsils, uvula, and soft palate.
Class II: Visibility of hard and soft palate, upper portion of tonsils, and uvula.
Class III: Soft and hard palate and base of the uvula are visible.
Class IV: Only hard palate visible.

Question 10

3-3-2 Rule - Breakdown

Answer 10

3-3-2 Rule
3: The width of the mouth opening should be at least three fingers.
3: The distance from the hyoid bone to the chin should also be three fingers.
2: The distance from the thyroid notch to the floor of the mouth should be two fingers.