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Best place to suffer a cardiac arrest?

Posted Oct 17 2012 12:00am
Mask sealBushy beards, crusted blood on the face, or disruption of lower facial continuity Obesity / ObstructionObesity, pregnancy, angioedema, Ludwig’s angina, upper airway abscess, epiglottitis AgeAge > 55 No teethMay leave denture in edentulous patients. Sleep apnea / Stiff lungsCOPD, asthma, ARDS, others
Can you list the predictors of a difficult airway?





1. Difficult Bag-Mask Ventilation
    Mnemonic = MOANS







Mallampati classification

2. Difficult Laryngoscopy and Intubation
    Mnemonic = LEMON


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



3. Difficult Extraglottic Device 
    Mnemonic = RODS


Restricted mouth opening Obstruction Disrupted or Distorted airway Stiff lung or cervical Spine




Difficult Cricothyrotomy
Mnemonic = SHORT


Surgery or other airway obstruction Hematoma (includes infection/abscess) Obesity Radiation distortion (and other deformity) Tumor

There are no absolute contraindications to performing an emergency cricothyrotomy.

References
Walls  R, Murphy M. Chapter 7: Identification of the Difficult Airway. Manual of Emergency Airway Management. Third Edition. Lippincott Williams & Wilkins
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