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3. Difficult Extraglottic Device
Specialty: Emergency Medicine
2. Difficult Laryngoscopy and Intubation
Posted Oct 17 2012 12:00am
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
Bushy beards, crusted blood on the face, or disruption of lower facial continuity|
1. Difficult Bag-Mask Ventilation
Mnemonic = MOANS
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.
Mnemonic = RODS
Restricted mouth opening
Disrupted or Distorted airway
Stiff lung or cervical Spine