PRE-INTUBATION AIRWAY ASSESSMENT
Published on Jul 31, 2016
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PRESENTATION OUTLINE
AIRWAY ASSESSMENT
Comprehensive Pre-Intubation Checklist
The following is a 9-step pre-intubation airway assessment.
Mnemonic courtesy of Dr. Jeremy Sperling, Jacobi Medical Center
Mnemonic courtesy of Dr. Jeremy Sperling, Jacobi Medical Center
Photo by liverpoolhls
LOOK (EXTERNALLY)
First step is always a quick external assessment. Is the patient agitated or sedated? Is there evidence of trauma or external facial hair that would create a challenge to intubation?
EVALUATE
- "3-3-2" Rule
- 3 -finger breadths- open mouth
- 3 -finger breadths- mentum to hyoid
- 2 -finger breadths- hyoid to thyroid cartilage
Evaluate for adequate airway diameter, temporomandibular joint mobility, and neck length. Is there reason to suspect challenges to visualization or laryngoscope placement?
Photo by Juliana Coutinho
obstructions
Any foreign bodies or abscesses in the perioral/oral cavity? Any evidence of foreign body aspiration?
Photo by Dave Lanovaz
NECK MOBILITY
Does the patient present with cervical spinal precautions that would create a challenge to laryngoscope placement? Is there history of rheumatoid arthritis or degenerative disease that would create a limitation to neck mobility?
mask difficulty
Any reason to suspect difficulties with a firm airway seal? Facial piercings? Lesions, bandages, broken bones, hemorrhaging?
OBESITY
Does the persons body habitus pose a risk of early hypoxia? Challenges due to excessive tissue obstruction?
AIRWAY DIFFICULTY
Any adenopathy or tonsillar abnormalities? Any oral candidiasis, esophagitis, or glossitis visualized?
no teeth
Does the patient have dentures that require removal prior to intubation? Anything that could be dislodged?
Photo by sander_123
stiff lungs
Any evidence in patient's past medical history to suggest pulmonary fibrosis? Any occupational exposure? Evidence of aspiration, COPD, smoking history, emphysema?
SUmmary - "leon MOans"
- (L)ook externally, (E)valuate 3-3-2, (O)bstructions, (N)eck mobility
- (M)ask difficulty, (O)besity, (A)irway difficulty, (N)o teeth, (S)tiff lungs
"LEON MOANS" is an essential, comprehensive 9-step airway assessment that can be completed at bedside within 90 seconds, allowing the intubator to visualize the procedure and foresee any obstacles to the airway prior to beginning the intubation.
