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Mouth, Mandible
Measure the size of the mouth opening. It should be three finger-widths. Anything less may limit your view. The mandible should be midline without deformity or trauma.
Excessive Weight
Obese patients are notoriously hard to intubate and ventilate as a result of the large size / weight of their chest.
Deformity
Look for any face or neck deformities or masses. These may be traumatic or baseline deformities such as a goiter.
Incisors
Buckteeth are bad. Also look for dentures or other dental appliances. Loose and decayed teeth are especially fragile.
C-Spine
The longer the neck, the better. This makes lining up the airway with the oral cavity easier. The head and neck should ideally be in the sniffing position (not in trauma with suspected c-spine injuries). Expect c-spine immobilized patients to be more difficult than normal.
Thyromental distance
This is the distance from the chin to the thyroid cartilage. It should also be three fingerbreaths in distance. Shorter is harder.
Uvula
This is the same as the Mallampati classification. The more uvula you see, the better.
Burns
Look for burns or other injuries that may lead to airway edema. Though you may be able to line up the airway well, you may not be able to visualize the cords or pass the tube if excessive swelling is present. These conditions also make it particularly hard to bag the patient and should be taken into account if you are planning on Rapid Sequence Intubation.
Emesis
Barf, blood, and secretions are always bad.
Stridor
This is another clue to possible edema or foreign body. [9] |