Difficult airway Mnemonics

Difficult to Bag (BONES)

Beard
Obesity
No Teeth
Elderly (>55)
Snores

Difficult to Intubate (LEMON)

Look at head and neck
Evaluate 3-3-2
Mallampati
(Using Samsoon and Young mod, which added class IV, 1987)
Obstruction=hot potato voice, can’t handle secretions, and Stridor (if audible=90% obstruction)
Neck Mobility

Difficult Extraglottic Device (RODS)

Restricted Mouth Opening
Obstruction: at or below the level of the larynx
Disrupted or distorted airway. If the seat or seal of the device is disrupted
Stiff lungs or cervical spine. Poor lung compliance or inability to extend neck may hamper seal

Difficult Cricothyrotomy (SHORT)

Surgery/Disrupted Airway
Hematoma
Obese/Access Problems (Can’t get to neck)
Radiation
Tumor

Difficult Physiology (HOP)

Hypotension – either preintubation or the potential for intubation to cause it
Oxygenation – either already satting poorly or the patient has minimal reserve
pH -Ventilatory kills. Either the patient has a severe metabolic acidosis, or they are a brain injury patient with potential ICP issues.

Comments

The pressure volume loop...

In the pressure-volume loop below, cardiac work is best represented by: the area of the curve the slope of the line from points C to D the distance of the line from points C to D the slope of a line from points A to D .. .. ... .... ... .... .... .... In the pressure-volume loop below, cardiac work is best represented by: the area of the curve Cardiac work is the product of pressure and volume and is linearly related to myocardial oxygen consumption. Cardiac work is best represented by the area of the curve of a pressure-volume loop.

Driving Pressure in ARDS: A new concept!

Driving Pressure and Survival in the Acute Respiratory Distress Syndrome Marcelo B.P. Amato, M.D., Maureen O. Meade, M.D., Arthur S. Slutsky, M.D., Laurent Brochard, M.D., Eduardo L.V. Costa, M.D., David A. Schoenfeld, Ph.D., Thomas E. Stewart, M.D., Matthias Briel, M.D., Daniel Talmor, M.D., M.P.H., Alain Mercat, M.D., Jean-Christophe M. Richard, M.D., Carlos R.R. Carvalho, M.D., and Roy G. Brower, M.D. N Engl J Med 2015; 372:747-755 February 19, 2015 DOI: 10.1056/NEJMsa1410639 BACKGROUND Mechanical-ventilation strategies that use lower end-inspiratory (plateau) airway pressures, lower tidal volumes (V T ), and higher positive end-expiratory pressures (PEEPs) can improve survival in patients with the acute respiratory distress syndrome (ARDS), but the relative importance of each of these components is uncertain. Because respiratory-system compliance (C RS ) is strongly related to the volume of aerated remaining functional lung during disease (termed functional lung size)...

Anaphylaxis updates part 2- Empty Ventricle Syndrome

Patients with anaphylaxis should not suddenly sit, stand, or be placed in the upright position. Instead, they should be placed on the back with their lower extremities elevated or, if they are experiencing respiratory distress or vomiting, they should be placed in a position of comfort with their lower extremities elevated. This accomplishes 2 therapeutic goals: 1) preservation of fluid in the circulation (the central vascular compartment), an important step in managing distributive shock; and 2) prevention of the empty vena cava/empty ventricle syndrome, which can occur within seconds when patients with anaphylaxis suddenly assume or are placed in an upright position. Patients with this syndrome are at high risk for sudden death. They are unlikely to respond to epinephrine regardless of route of administration, because it does not reach the heart and therefore cannot be circulated throughout the body

sedationstation

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