On June 28th at 5pm EST, I will be appearing on AirwayWorld.com 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.
Scott Weingart
An ED Intensivist from NY.
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12 Comments on "The HOP Mnemonic and AirwayWorld.com Next Week"
“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.
I will now be HOPping and HOPing before prior to all me tubes. Thanks.
Matt
[…] In a recent paper in the Western Journal of Emergency Medicine, Mosier et. al. talk about the “physiologically difficult airway” – a very good and nicely written perspective on airway management in the critical patient (full paper available for free here). It expands on topics already mentioned by (who else?) Scott Weingard a few years back. […]
My god the “SHORT” reference with the “Full Metal Alchemist” is fantastic. I wonder how many people actually got that reference…
tee hee
[…] was mostly derived from a podcast by Scott Weingart (Twitter: @EMCrit) where he talked about the physiologic killers during preintubation and perintubation. In this podcast, Scott mentions the HOp killers: Hypotension, Hypoxemia, and Metabolic Acidosis […]
[…] was mostly derived from a podcast by Scott Weingart (Twitter: @EMCrit) where he talked about the physiologic killers during preintubation and perintubation. In this podcast, Scott mentions the HOp killers: Hypotension, Hypoxemia, and Metabolic Acidosis […]
[…] was mostly derived from a podcast by Scott Weingart (Twitter: @EMCrit) where he talked about the physiologic killers during preintubation and perintubation. In this podcast, Scott mentions the HOp killers: Hypotension, Hypoxemia, and Metabolic Acidosis […]
[…] was mostly derived from a podcast by Scott Weingart (Twitter: @EMCrit) where he talked about the physiologic killers during preintubation and perintubation. In this podcast, Scott mentions the HOp killers: Hypotension, Hypoxemia, and Metabolic Acidosis […]
[…] was mostly derived from a podcast by Scott Weingart (Twitter: @EMCrit) where he talked about the physiologic killers during preintubation and perintubation. In this podcast, Scott mentions the HOp killers: Hypotension, Hypoxemia, and Metabolic Acidosis […]
[…] was mostly derived from a podcast by Scott Weingart (Twitter: @EMCrit) where he talked about the physiologic killers during preintubation and perintubation. In this podcast, Scott mentions the HOp killers: Hypotension, Hypoxemia, and Metabolic Acidosis […]
[…] was mostly derived from a podcast by Scott Weingart (Twitter: @EMCrit) where he talked about the physiologic killers during preintubation and perintubation. In this podcast, Scott mentions the HOp killers: Hypotension, Hypoxemia, and Metabolic Acidosis […]