Airway Emergencies - assessment - 1

Airway Emergencies Cardiovascular Emergencies Trauma Human Performance Anaesthetic Emergencies

Identifying the “difficult to intubate patient”

• Long incisors / Overriding upper teeth
• Poor TMJ function / mouth opening < 3cm
• Mallampatti 3 or 4
• Small jaw
• Narrow palate
• Thryomental distance < 6 cm
• Rigid submandibular space from infection or tumour
• Impaired mobility of cervical spine

Identifying the patient likely to be difficult to mask ventilate

• Elderly
• Edentulous
• Obese
• Snorers / Sleep apnoea
• Bearded
• Patients with airway obstruction (stridor)

Pathologic Causes of a Difficult Airway

• Congenital and surgically induced facial and upper airway deformities
• Maxillofacial and airway trauma including oedema
• Airway tumours, abscesses and haematomas
• Cervical trauma
• Fibrosis of face and neck

Anatomical Causes of Difficult Airway

• Relative tongue/pharyngeal size
• Mallampati classification
• Extent of mandibular opening
• Mandibular space
• Thyromental distance
• Horizontal length of mandible
• Atlanto-occipital joint extension

assessment one | assessment two

St. Vincent's Hospital Melbourne. Department of Anaesthesia. ©2003

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If it is recognized that intubation or mask ventilation is going to be difficult because of the presence of pathologic factors or a combination of anatomic factors, then the airway should be secured while the patient is awake.