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.