Can you list the difficult airway predictors? Do you know the mnemonics: MOANS, LEMON, RODS, and SHORT?


1. Difficult Bag-Mask Ventilation (MOANS)

Mask sealBushy beards, crusted blood on the face, or disruption of lower facial continuity
Obesity / ObstructionObesity, pregnancy, angioedema, Ludwig’s angina, upper airway abscess, epiglottitis
AgeAge > 55
No teethMay leave denture in edentulous patients.
Sleep apnea / Stiff lungsCOPD, asthma, ARDS, others

Mallampati classification

2. Difficult Laryngoscopy and Intubation (LEMON)

Look externallyUse your clinical gestalt, evidence of lower facial disruption, bleeding, small mouth, agitated patient
EvaluateUse the 3-3-2 rule: mouth open, mandible, glottis
Mallampati scoreIn order of increasing difficulty Class I-IV
Obstruction / ObesityFour cardinal signs of upper airway obstruction: stridor, muffled voice, difficulty swallowing secretions, sensation of dyspnea. Obese patients frequently have poor glottic views.
Neck mobilityMay not be able to optimally move the head and neck due to trauma, arthritis, ankylosing spondylitis. Immobilize the neck and consider using video laryngoscopy.

3. Difficult Extraglottic Device (RODS)

estricted mouth opening
isrupted or istorted airway
tiff lung or cervical Spine

4. Difficult Cricothyrotomy (SHORT)

urgery or other airway obstruction
ematoma (includes infection/abscess)
adiation distortion (and other deformity)

There are no absolute contraindications to performing an emergency cricothyrotomy.

Walls  R, Murphy M. Chapter 7: Identification of the Difficult Airway. Manual of Emergency Airway Management. Third Edition. Lippincott Williams & Wilkins

Javier Benitez, MD

Javier Benitez, MD

ALiEM Featured Contributor
Javier Benitez, MD


Medical doctor, tweets not medical advice or endorsements. Interested in #MedEd & technology. Always learning. I'm no expert. No financial conflict of interest.
Javier Benitez, MD