Take a listen to our airway episode on human factors and why preparation is crucial.
General Strategy & Airway Management Plan: A, B, C
Mnemonic for airway preparation: STOP MAID
General Recommended Approach for APP Intubations
Airway Assessment Mnemonics
Difficult LMA = RODS
- Restricted mouth opening
- Distorted airway
- Stiff lungs or c-spine
Difficult surgical airway = SHORT
- Radiation distortion or other deformity
Difficult intubation = LEMON
- Look externally
- Evaluate 3-3-2 rule
- Mallampati score
- Neck Mobility
Difficult BVM = BONES
- No teeth
- Sleep Apnea / Snoring
- Class I: Soft palate, uvula, fauces, pillars visible
- Class II: Soft palate, uvula, fauces visible
- Class III: Soft palate, base of uvula visible
- Class IV: Only hard palate visible
- Grade 1: Full view of glottis
- Grade 2a: Partial view of glottis
- Grade 2b: Only posterior extremity of glottis seen or only arytenoid cartilages
- Grade 3: Only epiglottis seen, none of glottis seen
- Grade 4: Neither glottis nor epiglottis seen
Further topics on Oxygenation
Delayed Sequence Intubation
The Failed Airway
When a failed airway is encountered, step one is to declare it as a failed airway and call for assistance. The goals transition from securing an orotracheal airway to maintaining oxygenation. Specific recommended steps can be found in the failed airway algorithm on the right.
If true can't intubate, can't oxygenate (CICO), emergent cricothyrotomy should be performed. We prefer the scalpel-finger-bougie technique.
Real, Live Crics
Emcrit on the Surgical Airway
Use of the Bougie
LaMW: Intubating the Hypotensive Patient
The "BURP Maneuver" of Backwards Upwards Rightwards Pressure aka Bimanual Laryngoscopy. It is pressure applied to the thyroid cartilage of the upper Adam's Apple and not the cricoid cartilage. It reverses the distorting forces of the laryngoscope's lift, and can optimize the view of the notorious "Anterior Larynx."
POCPOM or Pull Out Cheek - Push On Maxilla manuever is used when the intubator is hampered by a crowded oral cavity: small mouth or limited mouth opening due to arthritis, jaw trauma, TMJ problems, buck teeth; angioedema, tongue swelling, etc.
Bed Up - Head Elevated (BUHE)
BUHE or Bed Up Head Elevated is the optimal position for pre-oxygenation and induction of morbidly obese patients. The head up position maximizes view during direct laryngoscopy, while the bed elevation increases chest wall compliance to facilitate BMV.
BUHE may even be beneficial for all airways if feasible. See BUHE Video and this article: Head-Elevated Patient Positioning Decreases Complications of Emergent Tracheal Intubation in the Ward and Intensive Care Unit.