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