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Flashcards in Airway Assessment Deck (15)
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1

N.B. About Airway Assessment

Patient’s airway MUST ALWAYS BE EXAMINED.
Airway must be Maintained, Protected and Secured

2

Predicting a difficult airway

Assessed whether there might be potential difficulty in four key scenarios
Difficulty with bag-mask ventilation
Difficulty with intubation
Difficult rescue of the airway with a supraglottic airway if the above fail
Difficulty with front-of-neck access (FONA) if all three of the above fail
Some factors affect both BMV and intubation (e.g. obesity), others primarily BMV (e.g. a large beard), others primarily intubation (e.g. abnormal dentition)

3

Hx specific for AIRWAY ASSESSMENT

Previous anaesthetic history (check records) including airway management.
History of congenital, acquired/traumatic pathology affecting airway.
Previous head or neck surgery.
Previous radiotherapy to airway / head area.

4

Systematic Approach to Clinical Airway Examination

1) Face
2) Mouth
3) Dentition/teeth
4) Neck and its range of movement
5) Trachea

5

Airway Assessment: FACE

Overt tumours
Congenital syndromes (Trisomy 21, Pierre-Robin Sequence)
Facial trauma
Facial hair

6

Airway Assessment: MOUTH

Assess the MOUTH OPENING (3 fingers of patient or >5)
Look for macroglossia
Look for tumours, trauma, other masses
The MALLAMPATI SCORE is a predictor of difficult intubation

7

Airway Assessment: DENTITION

Can make laryngoscopy and intubation difficult due to:
-NO TEETH
-MISSING TEETH
-PROMINENT TEETH
-LOOSE TEETH
-DENTAL WORK

8

Airway Assessment: NECK

1) Fist EXCLUDE C-SPINE INJURY (if suspected, appropriate precaution)
2) Assess the LENGTH (N±8cm) and THICKNESS (N±33cm) of the neck
3) RANGE OF MOVEMENT:
Extension and flexion (A and P positioning (mandible-occipital)
The THYROMENTAL (N±6.5cm) and STERNOMENTAL (N±12.5cm) (distances, if reduced, are predictors of difficult intubation)
4) Check whether the TRACHEA is central

9

Factors for Difficulty of Bag Mask Ventilation (BONES)

ALWAYS POSITION THE PATIENT PROPERLY (neck flexion and head extension)
Ear and sternal notch at same plane

Beard
Obesity
No teeth
Elderly
Snoring (Sleep Apnoea)/Stiff lungs
REMEMBER TECHNIQUES
Head tilt chin lift
Jaw Thrust
Vice Grip

10

Factors for Difficulty Intubation LEMONS

Look externally THINK D's
Evaluate 3-3-2 rule and distances
Mallampati Score of >/=3
Obstruction (infection masses)
Neck Mobility (A-O)
Spine (C) Stiff neck

11

Factors for Difficulty Intubation
4 “D”s

1) DISPROPORTION
Macroglossia (big tongue)
Micrognathia (small chin)
High-arched palate
Bony abnormalities
Short thick neck
2) DISTORTION
Airway trauma
Epiglottitis
Laryngeal tumours
3) DYSMOBILITY
Limited mouth opening
Fixed cervical spine / decreased extension
Cervical spine injury
4) DENTITION
NO TEETH
MISSING TEETH
PROMINENT TEETH
LOOSE TEETH
DENTAL WORK

12

Mallampati Classification

Class I: Complete visualisation of soft palate
Class II: Complete visualisation of the uvula
Class III: Visualisation of the base of the uvula
Class IV: Soft palate is not visible (ALSO CAN'TS LMA)

13

Factors for Difficulty SGA (LMAs)
RODS

Restrictive mouth
Obstructive
Distortion/Disruption (infection)
Stiff lungs (C-spine)

14

Factors for Difficulty Surgery (SHORTY)

Surgery/Scar
Haematoma
Obesity
Radiotherapy
Tumour/Trauma
Young

15

Factors for Difficulty due to physiological problems (AHH)

Acidosis
Hypoxia
Hypertension