Difficult airway

management
Dr.Dharshana
MEM [GW]
• DIFFICULT
TO INTUBATE
• DIFFICULT
TO
VENTILATE
IF YOU GET A CALL TO ATTEND THIS CASE

CHECK YOUR PULSE RATE

DIFFICULT TO INTUBATE
DIFFICULT TO INTUBATE
LEMON

• Look externally.
• Evaluate the 3-3-2 rule
• Mallampatti grading
• Obstruction
• Neck mobility
L: Look Externally
• Obesity
• Short neck
• Prominent Upper Incisors
• Dentures
• Burns
• Facial Trauma
• Macroglossia
E-Evaluate the 3-3-2 rule

• 3 fingers fit in mouth

• 3 fingers fit from mentum to hyoid cartilage
• 2 fingers fit from the floor of the mouth to
the top of the thyroid cartilage
Cormack & Lehane Grading
O: Obstruction ?

1. Blood
2. Vomitus
3. Teeth
4. Epiglottis
5. Dentures
6. Tumors
N-Neck mobility
Measurement of
Atlanto-Occepital Angle
• WHAT ARE ALL THE
CAUSES OF DIFFICULT
INTUBATION ?
CAUSES OF
DIFFICULT INTUBATION
• Patients:
• Congenital causes
• Acquired causes
• Equipments
• Inadequate equipments.
• Experience not enough.
• Poor technique.
• Malfunctioning of equipment.
MANAGEMENT PLAN OF
ANTICEPATED
DIFFICULT AIRWAY

1. Discussion with colleagues in advance.

2. Equipment tested before.
3. Senior help backup.
Plan “A”

• Intubation - 2 tries
• Different Length of blade
• Different Position
 Plan “B”:
• Bag and mask ventilation
• (AMBU)
PLAN C - LMA
•Plan “D”:
(CRIC) Needle, Surgical
DIFFICULT TO
VENTILATE
• WHAT ARE ALL THE SIGNS OF
INADEQUATE VENTILATION ?
SIGNS OF INADEQUATE
VENTILATION
• Decrease in saturation
• Absent or inadequate chest movement
• Absent breath sound
• Gastric air entry or dilatation
• Cyanosis
• Hypoxia or hypercarbia
Causes :

•
DOPE
• D-displacement of tube
• O-obstruction
• P-
• E-
Difficulty in BMV
The Unexpected Difficult Airway

• Experienced help may not be immediately available

• Special equipment may not be immediately available
• Backup airway management plans may be poorly
thought out
OVERVIEW