Airway Assessment

• Key thought processes
  • Treat all airways as potentially difficult. Use LEMON acronym.
  • What is your back up airway plan? Have multiple options.
  • Is bag mask ventilation going to be difficult?
  • Does the patient need prep for surgical airway?

Preoxygenation

• Key thought processes
  • Is your nasal cannula in place for apneic oxygenation?
  • Is the patient pre-oxygenating appropriately with non-rebreather? 
  • Is the patient positioned appropriately (elevate head of bed!)?
  • Does the patient have shunt physiology that requires NIV for pre-oxygenation? 
  • Is the patient non cooperative with pre-oxygenation? Do you need to consider DSI (Delayed-sequence intubation)?

Opening the Airway

• Key thought processes 
  • s there evidence of foreign body/trauma or fluid obstructing the airway?
  • Do you have suction available at the bedside?
  • s the head of the bed elevated?
  • Does the patient respond to simple positioning maneuvers such as chin lift and jaw thrust?
  • Will the patient tolerate an oral or nasal airway to assist with oxygenation?

http://vimeo.com/34883844

The Bag Valve Mask

• Key thought processes
  • Is it easy to ventilate the patient? Do you need to consider alternate airway immediately such as extra-glottic device or surgical airway?  
  • Do you have nasal cannula in place for apneic oxygenation during BVM?
  • Is a PEEP valve available?
  • Do you have a good seal? Is there chest rise?
  • Can you perform BVM with an assistant to improve oxygenation?
  • Is the patient edentulous? Adjust mask positioning accordingly. 

http://vimeo.com/17542057

http://emupdates.com/2010/06/09/screencast-advanced-airway-management-for-the-emergency-physician/

Laryngoscopy

• Key thought processes 
  • Is the patient hemodynamically unstable, not oxygenating or severely acidotic? Can any of these be fixed before proceeding with laryngoscopy? 
  • What are your intubation meds?
  • What is your plan for the airway if your first modality fails? (Verbalize) Are your alternate airway adjuncts set up and ready at bedside?
  • Have you gone through your intubation checklist, whether written or mental?
  • Are you psychologically prepared for the airway? Take your time.