Mnemonics for difficult airway predictors

Oct 17, 12
Mnemonics for difficult airway predictors

Can you list the difficult airway predictors? Do you know the mnemonics: MOANS, LEMON, RODS, and SHORT?


1. Difficult Bag-Mask Ventilation (MOANS)

Mask seal Bushy beards, crusted blood on the face, or disruption of lower facial continuity
Obesity / Obstruction Obesity, pregnancy, angioedema, Ludwig’s angina, upper airway abscess, epiglottitis
Age Age > 55
No teeth May leave denture in edentulous patients.
Sleep apnea / Stiff lungs COPD, asthma, ARDS, others

Mallampati classification

2. Difficult Laryngoscopy and Intubation (LEMON)

Look externally Use your clinical gestalt, evidence of lower facial disruption, bleeding, small mouth, agitated patient
Evaluate Use the 3-3-2 rule: mouth open, mandible, glottis
Mallampati score In order of increasing difficulty Class I-IV
Obstruction / Obesity Four cardinal signs of upper airway obstruction: stridor, muffled voice, difficulty swallowing secretions, sensation of dyspnea. Obese patients frequently have poor glottic views.
Neck mobility May not be able to optimally move the head and neck due to trauma, arthritis, ankylosing spondylitis. Immobilize the neck and consider using video laryngoscopy.

3. Difficult Extraglottic Device (RODS)

estricted mouth opening
isrupted or istorted airway
tiff lung or cervical Spine

4. Difficult Cricothyrotomy (SHORT)

urgery or other airway obstruction
ematoma (includes infection/abscess)
adiation distortion (and other deformity)

There are no absolute contraindications to performing an emergency cricothyrotomy.

Walls  R, Murphy M. Chapter 7: Identification of the Difficult Airway. Manual of Emergency Airway Management. Third Edition. Lippincott Williams & Wilkins

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Javier Benitez, MD

Javier Benitez, MD

ALiEM Featured Contributor

The post Mnemonics for difficult airway predictors appeared first on ALiEM.

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