Airway Assessment PDF

Airway Assessment Health Assessment Key Points An airway exam is performed on every patient for every encounter Anesthesia is the airway expert The airway exam is not 100% predictable of a difficult airway Always obtain old records if there is a question about the airway Know and be able to recite t...

Airway Assessment Health Assessment Key Points An airway exam is performed on every patient for every encounter Anesthesia is the airway expert The airway exam is not 100% predictable of a difficult airway Always obtain old records if there is a question about the airway Know and be able to recite the Difficult Airway Algorithm - it will save a life Arguably single most important aspect of assessment Airway Events Adverse respiratory events constitute the single largest source of injury in the Closed Claims Project Respiratory events are 64% of all claims in the 2000s Three mechanisms: Inadequate ventilation (25%) Difficult intubation (22%) Esophageal intubation (6%) Outcome, Payment, Frequency Components of Airway Exam Length of upper incisors Condition of teeth Occlusion and mouth opening Mandibular advance (mandibular prognathism) Interincisor or inter gum distance Visibility of uvula Facial hair Thyromental distance (TMD)/submental space Length of neck Neck circumference ROM of head and neck Documentation Requirements Mallampati score Status of teeth Degree of neck mobility Neck circumference TMD Body habitus Pertinent deformities Airway Exam Predictability No single exam/test is 100% predictive of a difficult airway The airway exam helps with anesthesia planning Most predictive factor = history of difficult intubation BUT, a previous ‘easy airway’ does not rule out potential difficulty Ventilation V. Intubation Ventilation will save a life Intubation is not required to ventilate Ventilation will save a life Intubation/laryngoscopy will mess up an airway Ventilation will save a life Intubation is not required to ventilate Ventilation will save a life Predictors of Difficult Ventilation BVM Any Ventilation Method Age > 55 years BMI > 26 Lack of teeth Beard Snoring history OSA Male OSA Snoring history Obesity Neck cir. > 17 inches Head/neck radiation Trauma RA Downs Syndrome C-Spine injury/deformity Difficulty in BVM Ventilation BOOTS B – beard O – obese O – older T – toothless S – snoring Full Beard Predictors of Difficult Intubation Facial deformities Decreased neck ROM Neck circumference >17 inches Interincisor distance