Difficult airways can be a challenge. The only thing more challenging than managing the airway, is trying to remember all of the difficult airway mnemonics that you were told to memorize at one point. While I am not a fan of mnemonics, they can be a useful way for your to remember the main points of a difficult airway assessment. Here are a few that are commonly used:

Difficult mask ventilation identification – MOANS

  • M Mask seal
  • O Obesity, Obstruction
  • A Age greater than 55
  • N No teeth
  • S Stiff neck, Snores

Difficult laryngoscope and intubation – LEMON

  • L Look externally
  • E Evaluate 3-3-2 rule
  • M Mallampatti assessment
  • O Obstruction
  • N Neck mobility

Difficult Intubation (Alternative) – HEAVEN

  • H Hypoxemia – SpO2 of 93% or less at time of laryngoscopy.
  • E Extremes of size – Peds patients 8 years of age or less and obese patients.
  • A Anatomic challenge – Anything that prevents visualization of anatomical structures necessary for airway management.
  • V Vomit/blood/fluid – Fluid in the airway.
  • E Exsanguination – Bleeding can cause anemia that could impact safe apnea times.
  • N Neck mobility issues – Anything that limits neck movement.

Difficult Cricothyrotomy – SHORT

  • S Surgery
  • H Hematoma
  • O Obese
  • R Radiation
  • T Tumor


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