The HOP Mnemonic and Next Week

On June 28th at 5pm EST, I will be appearing on for a lecture on DSI and NIV preox. It is free to register, so come check it out.

The folks that run the site are from the Emergency Airway Course. They like difficult airway assessment acronyms, such as:

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

Well during next week’s lecture, I will suggest one more to be added to the list:

Difficult Physiology (HOp)

The Physiologically Difficult Airway, aka you will box your pt during the intubation if you don’t take steps to prevent it: the HOp Killers

Here are the parts of the HOp mnemonic:

  • 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.

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  1. Mike Sherriff says

    “Make sure your patient isn’t HOPping before you intubate.”

    So when I read your tweet, I though HOP? What could that stand for?
    Hypoglycemic? Opiate overdosed? Post-ictal? Yeah that must be it. It’s poor form to intubate your patient, only to find out they are hypoglycemic, opiate overdosed or post-ictal.

  2. Scottweingartwannabe says

    I will now be HOPping and HOPing before prior to all me tubes. Thanks.

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