Anesthesia Airway Management ================= þ LEMON preparation for RIS mnemonic from Ron Walls' National Emergency Airway Course: - L: Look for anatomic features that may make ventilation or intubation difficult. + Morbid obesity + Facial or neck trauma + Large or jagged teeth + Protruding tongue + Facial hair + Narrow facial features - E: Examine the airway "the 3-3-2" rule + 3 finger mouth opening + 3 finger mentum to hyoid + 2 finger floor of mouth to thyroid cartilage - M: Mallampati score to predict laryngeal visualization + with patient seated, have them extend neck, open mouth and protrude tongue + observe the degree of visualization of the base of tongue, (if supine, open and depress with tongue blade, see what you can see, due to position will be one score lower) Class I: hard palate, soft palate, uvula, fauces, pillars visible Class II: hard palate, soft palate, uvula, fauces visible Class III: hard palate, soft palate, base of uvula visible Class IV: hard palate only visible - O: Look for any airway Obstructions: angioedema, hematoma, dentures, epiglottitis - N: evaluate Neck mobility + C-spine regitidy (immobilization or anatomic) reduces ability to alight the anatomic axes + Inability to mobilize the neck may make intubation difficult or impossible þ Anaesthesia (Sedation/Paralysis) for Intubation: þ Size of ET tube: - width of little fingernail - diameter of nares - 16+age / 4 þ Detecting Esophageal Intubations: þ Surgical Airways þ Sellick Maneuver: - 20 lbs. of pressure ("press on bridge of nose until it hurts, that's about 20 lbs. of pressure.) - teaching is that if patient actively vomits, release pressure and turn patient on side.