52 in 52: Airway Assessment Score

In preparation for airway simulation lab, we read:

Reed MJ, Dunn MJG, McKeown DW. 2005. Can an airway assessment score predict difficulty at intubation in the emergency department? Emerg Med J. 22(2):99-102.

Take home points:

LEMON criteria: ¬†(L- Look externally for characteristics known to cause difficulty; E- Evaluate the 3-3-2 rule; M- Mallampati; O- Obstruction; N-Neck mobility), and compared their findings to patients’ ¬†laryngoscopic view. They found that patients were more likely to have a poor laryngoscopic view if they had large incisors; reduced inter-incisor distance; or reduced thyroid to floor of mouth distance. From this, they proposed the following airway assessment score:

  • Number of positive unfavorable “look” criteria: 0-4 points
  • Mouth opening less than 3 finger breadths: 1 point
  • Hypo-mental distance less than 3 finger breadths: 1 point
  • Thyro-hyoid distance less than 2 finger breadths: 1 point
  • Presence of an obstructed airway: 1 point
  • Presence of poor neck mobility: 1 point

The more points a patient has may correlate with a more difficult laryngoscopic view.




  1. Thanks Anna for this great post.

    One thing I’ve also stopped doing is cricoid pressure during intubations. I listened to a POD Cast that showed there was no evidence to support doing it and they described a situation that actually happened to me in MTC:

    I had an overzealous med student holding cric pressure and I couldn’t pass the tube. After some sweating, some bagging, and a 6-0 tube, I realized it was the cric pressure collapsing the larynx around the vocal cord. We then passed the tube easily.

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