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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.


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