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Difficult airway criteria

HEAVEN Criteria: Derivation of a New Difficult Airway

  1. The HEAVEN criteria represent a set of difficult airway predictors that may be applied prospectively by emergency airway personnel, facilitating airway decision making. These criteria should be validated prospectively. HEAVEN Criteria: Derivation of a New Difficult Airway Prediction Too
  2. Definition of a difficult airway: Difficult intubation has been defined as one that requires external laryngeal manipulation, laryngoscopy requiring more than 3 attempts at intubation, intubation requiring nonstandard equipment or approaches, or the inability to intubate at al
  3. A standard definition of the difficult airway cannot be identified in the available literature. For these Practice Guidelines, a difficult airway is defined as the clinical situation in which a conventionally trained anesthesiologist experiences difficulty with facemask ventilation of the upper airway, difficulty with tracheal intubation, or both
  4. Each letter of HEAVEN stands for the difficult airway characteristic: Hypoxemia - ≤93% at the time of initial laryngoscopy Extremes of size - Pediatric patient ≤8 years of age or clinical obesity Anatomic challenge - any structural abnormality that is anticipated to limit laryngoscopic vie
  5. ars in Neonatal and Fetal Medicine: The Neonatal-Fetal Airway . If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us
Difficult Airway Management in the Pregnant Patient

DIFFICULT AIRWAY ALGORITHM 1. Assess the likelihood and clinical impact of basic management problems: • Difficulty with patient cooperation or consent • Difficult mask ventilation • Difficult supraglottic airway placement • Difficult laryngoscopy • Difficult intubation • Difficult surgical airway access 2 difficult to assess, often not feasible, and an unreliable predictor of a difficult airway . 2. A multi-center prospective observational study of 3,300 patients validated the modified LEMON, or LEON, criteria, removing the Mallampati score from the assessment, as a reliabl Guidelines Difficult Airway Society Guidelines for the management of tracheal extubation Membership of the Difficult Airway Society Extubation Guidelines Group: M. Popat (Chairman),1 V. Mitchell,2 R. Dravid,3 A. Patel,4 C. Swampillai5 and A. Higgs6 1 Consultant Anaesthetist, Nuffield Department of Anaesthetics, Oxford Radcliffe Hospital NHS Trust, Oxford, U In general terms, an airway is considered difficult when oxygenation and ventilation cannot be achieved in the desired manner 'The difficult airway' represents a complex interaction between patient factors, the clinical setting, and the skills and preferences of the practitioner American Society of Anaesthesiologists Task Force definitions

The quest to forecast difficult airway (DA) management has spanned more than a half century. In that time, a plethora of scientific investigations, book chapters, editorials, lectures, and workshops have been devoted to this essential issue. Among all of them, practitioners seek to determine which criteria are dependable and which are not. The HEAVEN criteria (Hypoxemia, Extremes of size, Anatomic abnormalities, Vomit/blood/fluid, Exsanguination, Neck mobility issues) may be more relevant to emergency RSI patients. Objective: To validate the HEAVEN criteria for difficult-airway prediction in emergency RSI using a large air medical cohort

Difficult Airway Iowa Head and Neck Protocol

  1. Difficult airway assessment tools, such as Mallampati or LEMON [Look externally, Evaluate 3-3-2 rule, Mallampati, Obstruction, Neck mobility] combine intuitive elements (e.g., Look externally) with assessments developed in the pre-operative setting that require patients to be awake and cooperative (e.g., Evaluate 3-3-2 and Mallampati) [ 4, 5 ]
  2. Clinical Criteria for Airway Assessment: Correlations with Laryngoscopy and Endotracheal Intubation Conditions 321. routine preoperative tests with their respective undesir- able results (possible predictors of a difficult airway) [5]. Nevertheless, the diagnostic accuracy of airway assess
  3. Therefore as the number of criteria increase, so does the specificity or probability of a difficult airway. The predictive values however are not that great. Even at 5+ criteria our PPV is only 57%, meaning this criteria will fail at identifying a difficult airway in almost 1 in 2 patients (Not that useful)

articles were screened for relevance to the research aims and according to pre-determined exclusion criteria. We identified 38 published airway management algorithms. Our results show that most facemask employ a four-step process as represented by a flow chart, with progression from tracheal intubation, facemask. The HEAVEN criteria were found valid to predict difficult airways during preclinical emergency intubations in a retrospective study. The acronym stands for Hypoxemia, Extremes of size, Anatomic abnormalities, Vomit/blood/fluid, Exsanguination/anaemia, and Neck mobility issues In this case sensitivity helps rule out a difficult airway while specificity helps rule in a difficult airway. Therefore as the number of criteria increase, so does the specificity or probability of a difficult airway. The predictive values however are not that great. Even at 5+ criteria our PPV is only 57%, meaning this criteria will fail at. Applications open on 26/02/2021 and close at midnight on 31/05/2021. We are delighted to announce that applications for the DAS Professor of Anaesthesia and Airway Management 2022 are now welcome! Please click here for the criteria. Please click here for the application form. Awards will be presented at next DAS ASM

Difficult airway management algorithms, along with cognitive aids, may reduce cognitive overload and provide a framework for appropriate decision-making 4. For the purposes of this review, definitions for difficult airway and difficult airway algorithm were adopted from the American Society of Anesthesiologists (ASA) 5. Before the advent of. Most approaches to emergency airway management reference the Look externally, Evaluate 3-3-2 rule, Mallampati, Obstruction, Neck mobility (LEMON) criteria, which represent a set of difficult airway predictors derived for use in the preoperative clinical setting before elective operative cases. 8 Several limitations exist with the application of.

1To facilitate the management of the difficult airway and to reduce the incidence of severe adverse outcomes during airway management, practice guidelines have been established, 2-4and several algorithms have been developed. One component of many such algorithms is the preoperative assessment and recognition of the difficult airway The LEMON airway assessment score based successfully predicts difficult poor laryngoscopic views although not necessarily predict airway intubation failure. Mallampati Score. 3-3-2 ruleDistance between patient's incisor teeth of 3 finger breadths and distance between the thyroid notch and the floor of the mouth should be at least 2 finger widths Download Guidelines -click here. The DAS documents on Management of Extubation are now available on the DAS website. The DAS algorithms can be reproduced for non-commercial purposes without explicit request for permission as long as there is proper citation. For more information click here. Tags: guidelines Documentation of a difficult airway is often subjective and inconsistent 8,9 and by including the use of adjunctive airway equipment in our definition, we aimed for more objective criteria. Results During the two-month pilot period, twenty-one patients were identified by rapid response nursing assessments as having a known or suspected.

Practice Guidelines for Management of the Difficult Airway

The HEAVEN Criteria Part 2 - Predicting Challenging

The decision to use neuromuscular blockade for emergency intubation hinges on the provider's bedside assessment of difficulty with either laryngoscopy or rescue mask ventilation. If significant difficulty is predicted and laryngoscopy, intubation, or mask ventilation is not expected to be successful, then neuromuscular blockers are often withheld to avoid a failed airway situation Determining the presence of an anatomically difficult airway is a critical step in deciding the best approach to tracheal intubation. This topic review will discuss the incidence, assessment, and management of the anatomically difficult airway in adults outside of the operating theater. Other aspects of airway management, including pediatric. Airway assessment if a fundamental part of patient assessment. It helps predict a difficult airway and can help reduce the incidence of failed or difficult intubation. Several airway assessment tools have been developed to assess the many parameters involved in airway management

Difficult/Critical Airway Clinical Pathway — All Settings

Airway Assessment • LITFL Medical Blog • CCC Airwa

(Some) patients with difficult airways. This applies mainly to patients in whom maintenance of airway patency during induction was already challenging. Also be hesitant performing 'deep' extubation in patients who had surgery of or near the airway. Maintaining airway patency during wake-up after 'deep' extubation might now be a lot more difficult Patient's airway assessment was performed according to the LEON method (Fig. 1, left) as follows: (1) Look, look at the patient externally for characteristics that are known to cause difficult laryngoscopy, intubation, or ventilation—in the LEON method, Look criteria assesses for presence of four features (facial trauma, large. However, the Difficult Airway Society has a new guideline on awake intubation, and I wanted to cover some of my key takeaways from that document. (It is worth reading the whole article and it is open access.) The article. Ahmad I, El-Boghdadly K, Bhagrath R, et al. Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults 2. Purposes of the Guidelines for Difficult Airway Management The purpose of these Guidelines is to facilitate the management of the difficult airway and to reduce the likelihood of adverse outcomes. The principal adverse outcomes associated with the difficult airway include death, brain injury, cardiopulmonary arrest, unnecessary surgical.

Evaluation and Recognition of the Difficult Airway

The modified LEMON criteria do not include assessment of the Mallampati score or measurement of thyroid-to-mouth distance (part of the 3-3-2 rule). Of 4034 intubations, 84% were performed with a direct laryngoscope and, of these, 5.4% were difficult (required more than 1 attempt) All patients recruited had at least two criteria associated with a difficult airway, and approximately one in 10 had a prior history of a difficult airway. At the onset of the procedure, both groups were matched for total Arné score and Arné score subgroups (as delineated earlier). Oxygen saturation at the onset of laryngoscopy was no.

Difficult airway

A Novel Difficult-Airway Prediction Tool for Emergency

The HEAVEN criteria predict laryngoscopic view and

Emergency Department Pre-Intubation Checklist - Charlie's ED

The incidence, management and outcomes of patients with these difficult airway predictors were explored. During the study period, 220 records met the inclusion criteria. At least 1 difficult airway predictor was present in 183 (83.2%) patients; 57 (25.9%) patients had at least one LEMON feature, and 178 (80.9%) had at least one MOANS feature This may reflect widespread adoption of difficult airway guidelines which predominantly address induction of anaesthesia. In contrast, the claims for death or brain damage associated with maintenance, extubation, and recovery remained almost the same. 2 Development of specific airway management plans addressing these periods of risk should. The difficult airway with recommendations for management - Part 2 - The anticipated difficult airway. Can J Anesthesia. vol. 60. 2013. pp. 1119-1138 Background and Aims: Difficult tracheal intubation is associated with serious morbidity and mortality and cannot be always predicted based on preoperative airway assessment using conventional clinical predictors. Ultrasonographic airway assessment could be a useful adjunct, but at present, there are no well-defined sonographic criteria that can predict the possibility of encountering a.

Difficult tracheal intubation is one of the major reasons for anesthesia-related adverse events. Videolaryngoscopy has become an important part of the anesthesiology standard of care for difficult airway management in the past decades A failed tracheal extubation was defined as any adverse event related to the airway occurring within 6 h of extubation requiring reintubation. Results: A total of 519 patients were reported to have a difficult airway during this study period in a tertiary care pediatric center. Of these, 137 patients (26%) met inclusion criteria Consultant's Corner: Difficult Airways WITH ENT, Dr. PATIL. The difficult airway - a clinical situation in which a conventionally trained physician experiences difficulty with face mask ventilation and.or tracheal intubation. Evaluating for a difficult airway. Go through the same steps on every patient, every time the difficult airway include (but are not limited to): death, brain injury, cardiopulmonary arrest, predefined criteria for content as defined in the Focus of these Guidelines, or do not provide a clear causal interpretation of findings because of research design or analytic concerns

Only 7 intubations required use of a difficult airway device Annals of Emergency Medicine. 36(4): Part 2,A196, 2000 Incidence of the Difficult Airways 1-18% in OR depending upon criteria Failed laryngoscopy rate in OR: 5-35 in 10,000 Cannot intubate, cannot ventilate rate: 2 in 10,000 Difficult mask ventilation 5%, inability to mas Difficult airway (DA) is a clinical situation where a conventionally trained anaesthesiologist encounters difficulty in different aspects of management of the airway which include mask ventilation, laryngoscopy, video laryngoscopy, insertion of supraglottic airway device (SAD) and endotracheal intubation. Wilsons Criteria, Upper lip bite. Difficult intubation, inadequate ventilation and esophageal intubation are the principal causes of death or brain damage related to airway manipulation. The objective of this cross-sectional study was to correlate a preanesthetic evaluation that may be capable of predicting a difficult intubation with the conditions encountered at laryngoscopy and endotracheal intubation The Difficult Airway Society in the UK has comprehensive guidelines for airway management, including multiple algorithms. The integrated algorithm can be downloaded here (pdf). the Austin Hospital's algoirthm by George Douros above, is a modified version of the DAS integrated algorithm - note that the option of waking the patient up has.

MOANS difficult mask ventilation: LEMON difficult laryngoscopy: SHORT difficult cricothyrotomy: Mask Seal Obese Aged (>55 y/o) No Teeth Stiff: Look externally (gestalt) Evaluate 3-3-2 Mallampati Obstruction or Obesity Neck mobility: Surgery Hematoma or infection Obese Radiation Tumo Equally, patients with significant airway obstruction within the milieu of severe metabolic acidosis are physiologically troubling. A high respiratory rate coupled with long pulmonary time constants [lung unit resistance x compliance] results in air-trapping and auto-PEEP. The clinician should be especially cognizant of this complication not. The Difficult Airway Society's 2015 difficult intubation guidelines. CICV, cannot intubate, cannot oxygenate; DAS, Difficult Airway Society; GP, general practitioner, SAD, supraglottic airway device Reprinted with permission. 12 ANESTHESIOLOGYNEWS.COM oup unless otherwise noted. ohibited Difficult Laryngeal Mask Airway (LMA) Difficult Cricothyrotomy : R Restricted Mouth Opening O Obstruction D Distorted airway anatomy S Stiff Lungs / Neck: S Surgery H Hematoma, Have Infection (Abscess) O Obesity R Radiation T Trauma, Tumor * this is of limited use in non-elective intubations (e.g. Trauma).

The Emergency Department Pre-Intubation Checklist

An Emergency Difficult Airway Predictor Would be From

DIFFICULT AIRWAY. The fundamental responsibility of an anesthesiologist is to maintain adequate gas exchange in the patient. For this to be done, the patient's airway must be managed so that it is almost continuously patent. Failure to maintain a patent airway for more than a few minutes results in brain damage or death The following exclusion criteria were used for this study: if the patient had (1) age <18 or >90 years; (2) upper airway anatomical deformities, trauma, tumors or other diseases affecting the opening of the mouth, history of a difficult airway; (3) subglottic airway narrowing; and (4) unwillingness to participate in this study Difficult airway (defined as more than three attempts, or taking longer than 10 minutes) is the major factor in anesthesia morbidity [Caplan Anesthesiology 98: 1269, 2003]. The incidence of difficult airways is 1.1 - 3.8% [Miller] Anatomical Points. Nasopharynx separated from the oropharynx by the soft palate The Mallampati Classification is one way to predict a difficult airway. Learn the Mallampati score explained easily here.Follow Us on Social Media:Facebook:.

The Physiologically Difficult Airway - Part 1. To celebrate the birthday of Dr. Erin Hennessey [ @ErinH_MD] - my former co-fellow and current Stanford intensivist-anesthesiologist - I will interpret a relatively recent and terrifically high-yield overview of physiologically challenging intubations. In this must-read survey, the authors. airway parameters is important for an anaesthesiologist. Anaesthesia in a patient with a difficult airway can lead to both direct airway trauma and morbidity from hypoxia and hypercarbia. Direct airway trauma occurs during the management of difficult airway while excessive physical force is applied to the patient's airway more than the usua Assessing extubation criteria, and then deciding when to extubate a patient safely can sometimes be a difficult decision. Extubation Criteria. We all know the common extubation criteria: recovery of airway reflexes and response to command; inspiratory capacity of at least 15 ml/kg; no hypoxia, hypercarbia, or major acid/base imbalance References. 1. ASA Difficult Airway Taskforce. Practice guidelines for management of the difficult airway. Anesthesiology 2003; 98:1269-1277.. 2. Sagarin MJ, et al. Airway management by US and Canadian emergency medicine residents: A multicenter analysis of more than 6,000 endotracheal intubation attempts

The probable reasons for this may be the use of more strict criteria for difficult intubation, as described by intubation grades III and IV of Cormack and Lehane's grading rather than using only grade IV as difficult intubation or relying upon Cook's modification of Cormack and Lehane's grading. Gupta S, Sharma R, Jain D. Airway assessment. Shock Trauma Center (STC) Failed Airway Algorithm. January 26, 2013 by Scott Weingart, MD FCCM 33 Comments. The American Society of Anesthesia just released their new difficult airway guidelines. Of course, I'll be reviewing them on the Practical Evidence Podcast. Those guidelines are a bit too involved for Emergency Medicine and Intensive Care Apfelbaum JL, Hagberg CA, Caplan RA, Blitt CD, Connis RT, Nickinovich DG, et al. Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesiology. 2013;118:251-70. Article PubMed Google Scholar 2 The term difficult airway defies simple characterization as there is no published standard definition. It may be interpreted to indicate challenging or impossible mask ventilation (IMV), glottic visualization, and/or endotracheal tube placement. A reasonable set of criteria for predicting DMV/IMV may include history of DMV/IMV.

emDOCs

The Difficult Airway Course (Emergency or Critical Care) $1,600 or $1,500. AMEC faculty and staff at first course. $3,500 plus travel and hotel. ¹This rate is available to current members via promo code. Publisher retail price is $99.99. ²This on-line option is only available to members Prediction of difficult airway in ICU. In order to address the prediction of difficult airway in critically ill patients, De Jong et al. developed and validated a score (MACOCHA) in a multicentre study including 1000 intubations in 42 ICUs [].The score included seven parameters, out of which five were patient related (Mallampati >III or IV, obstructive sleep apnoea (OSA), reduced C-spine. Difficult airway management of a patient with limited range of motion in the temporomandibular joint and cervical extension caused by psoriatic arthritis: a To meet the CASPAR criteria, a patient must have inflammatory articular disease (joint, spine, or entheseal) with ≥ 3 points from the 5 categories. Difficulties or failure in airway management are still important factors in morbidity and mortality related to anesthesia and intensive care. A patent and secure airway is essential to manage anesthetized or critically ill patients. Oxygenation maintenance during tracheal intubation is the cornerstone of difficult airway management and is always emphasized in guidelines Patients in the difficult-intubation group had significantly higher LEMON scores than did those in the easy-intubation group. Of the criteria used to calculate the score, only large incisors, inter-incisor distance <3 fingerbreadths, and thyroid-to-floor-of-mouth distance <2 fingerbreadths were associated significantly with difficult intubation

Difficult airway management algorithms: a directed revie

Proper airway assessment and evaluation was carried out by an experienced consultant anaesthetist. All patients fulfilled the criteria of anticipated difficult intubation. Every patient had at least two criteria out of the history of difficult intubation, Mallampati Score III/IV, thyromental distance <6 cm, and neck circumference >40 cm The HEAVEN tool (Hypoxemia, Extremes of size, Anatomic distortion, Vomit/blood/fluid in the airway, Exsanguination/suspected anemia, Neck mobility limitations) was developed using a large air-transport registry to predict airway difficulty (Air Med J 2017; 36:195).In order to validate whether it predicts poor laryngoscopic view and difficult intubation, researchers retrospectively analyzed. An important aspect when dealing with a difficult airway is to be able to predict it and the difficult BMV. Several morphometric criteria and techniques have been developed and evaluated mostly for the patient in the OR. In a study of 1000 patients, the following characteristics emerged as risk factors for a difficult intubation: weight above. The distance from the hyoid bone to the thyroid notch is one finger widths. None of these criteria are associated with a more difficult airway. Next. Name that Mallampati Class. With the mouth open at rest, upper half of tonsillar fossa is visible. Choose at least 1 of the following: Mallampati Class 1. Mallampati Class 2 different airway parameters. To investigate the causes of a difficult airway, we analyzed pa-rameters of the look externally, evaluate 3-3-2, Mallampati score, obstruction, and neck mobility (LEMON) criteria before and after cervical collar application.6 METHODS Study design This simulation study was conducted at a general hospital fro

PPT - New Orleans EMS Airway Lecture Series: Lecture 2High Flow Oxygen in Anaesthesia and Critical Care : WFSA

HEAVEN Criteria: Prediction of Difficult Airway for In

Difficult Airway Predictors. Quick airway assessment. 1. Ask the patient to open their mouth wide then protrude their tongue: can assess Mallampati Score and TMJ movement. 2. Neck Circumference. 3. Dentition: can assess incisional measurement and presence of any chipped or loose teeth. 4 Trisomy 21 (Downs) - facial deformities, small mouth with macroglossia. 4. Mucopolysaccharidosis - facial features including thick lips, enlarged mouth and tongue, short stature, skeletal structure abnormalities, and OSA. Discuss some major acquired diseases associated with difficult airway management. 1 The Difficult Airway Course: EMS Essentials of Advanced Airway Management Fundamentals of Airway Management Airway on Demand Criteria to Be Listed. Continuing Medical Education. To be listed in our CME course section, the course must be ongoing (not a one-time offering) and open to all appropriate medical professionals.. We recommend using the Difficult Airway Society guidelines for management of unanticipated difficult intubation in adults (2015). The images below are linked to easy-to-follow pathways of care for emergency clinicians to use when managing patients with a difficult airway Local Anesthetic Allergy. Awake intubation with a well-anesthetized airway is not that uncomfortable, even with light or no sedation. If you can't numb the airway safely, then awake intubation would be difficult and painful to perform, leading to loss of cooperation and potentially patient refusal

Extubation and reintubation

The HEAVEN Difficult Airway Prediction Tool - Core E

Practice guidelines for management of the difficult airway: an update report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Anesthesio. 2013;118(2):251‐270 • Epstein SK, Ciubotaru RL, Wong JB Difficult Airway Society Extubation Guidelines G, Popat M, Mitchell V, et al. Difficult Airway Society Guidelines for the management of tracheal extubation. Anaesthesia. 2012;67(3):318-340. Lermitte J, Garfield MJ. Weaning from Mechanical Ventilation. Continuing Education in Anaesthesia, Critical Care and Pain, 2005; 5: 113-7

Difficult Airway Societ

Langeron et al. in 2000 specified inability to maintain saturations above 92%, using the oxygen flush more than twice, requiring 2 operators or a change of operator as indicators for difficult mask ventilation. 2 Yildiz et al. in 2005 defined the difficulty depending on the airway manoeuvres used. 3 Kheterpal et al. in 2006 defined difficult MV. Introduction Although preoxygenation and airway management respond to precise algorithms, difficult intubation (DI) remains a daily challenge in intensive care units and in the operating rooms because of its frequent complications, including hypoxaemia. To prevent desaturation during DI, high-flow oxygenation by nasal cannula (HFNC) could prove beneficial Study patients at risk for difficult tracheal reintubation were extubated using a No. 11 Cook airway exchange catheter (CAEC). Following tracheal extubation, the CAEC was secured, and humidified oxygen was insufflated through the central lumen (2 to 8 L/min) for a minimum of 4 h, during which oxyhemoglobin saturation (SpO 2) and respiratory frequency were monitored

EMCrit Podcast - Critical Care and Resuscitation

Difficult airway management algorithms: a directed review

See also. Resuscitation Emergency airway management in COVID -19 Intubation checklist. Key points. Specific measures to optimise physiology should be undertaken prior to every emergency intubation; Every emergency intubation should include early consideration of the need for help, clear team member role allocation, a clear plan for unsuccessful intubation, and strategies to help maintain. In this article, we will provide a framework for identifying a difficult airway, criteria for safe extubation, as well as review the devices that are available for airway management in the ICU. Proficiency in identifying a potentially difficult airway and thorough familiarity with strategies and techniques of securing the airway are necessary. EMS Airway Clinic is a new site offering best practices in airway management and education for EMS professionals and educators, featuring: Regular articles by Charlie Eisele, Flight Paramedic, retired First Sergeant with the Maryland State Police Aviation Command, and co-founder of the Advanced Airway Course at EMS Toda

Prediction of Difficult Mask Ventilation Anesthesiology

Difficult airway. An airway is assessed by the patient's ability or the physician's ability to oxygenate (provide oxygen) or ventilate (exhale carbon dioxide). Examples of a difficult airway include a thick neck/obese patient, head and neck structural abnormalities, lung disease In this era of advanced airway management, where we have a platter of airway equipments to choose from, RI seems to be an outdated technique so much so that even the difficult airway societies [including DAS (2015) and AIDAA (2016)] (Frerk et al. 2015; Myatra et al. 2016) have ignored it.These guidelines have mentioned more invasive techniques like cricothyroidotomy and tracheostomy as a last. An expert panel reviewed inclusion criteria, outcome, and airway management. Results. A total of 184 events met inclusion criteria: 36 in ICU and 15 in the ED. In ICU, 61% of events led to death or persistent neurological injury, and 31% in the ED. Airway events in ICU and the ED were more likely than those during anaesthesia to occu

Difficult airway guidelines have incorporated the laryngeal mask airway (LMA) since the 1990s and video laryngoscopy a decade later [9]. It is paramount to remember ventilation of a patient is a priority when faced with a difficult airway, either by a supraglottic device, invasive intervention, or where applicable, by waking the patient up [9] Sutagatti JG, Kurdi MS ((2016) Upper airway imaging and its role in preoperative airway evaluation. Med J 9: 300-306. Kundra P, Mishra SK, Ramesh A (2011) Ultrasound of the airway. Ind J Anaesth 55: 456-462. Crawley SM, Dalton AJ (2014) Predicting the difficult airway. Crit Care Pain 15: 253-257