Difficult Intubation App
Please enter the details of the event below:
Date
Patient Name
Healthcare Provider Contact
Name
Institution
Department
Anaesthesia
Emergency
Intensive Care
Other
Telephone Number
Email
Indication for Airway Management
Pre-OP Physical Characteristics
Reset Pre-OP Values
Mallampati Score
I
II
III
IV
Thyromental Distance < 6 cm
Yes
No
Mouth Opening < 3 Fingerbreadths?
Yes
No
Large Tongue?
Yes
No
Neck Mobility reduced ?
Yes
No
Radiation/Surgery to Head or Neck?
Yes
No
Congenital Abnormality?
Yes
No
Increased Aspiration Risk?
Yes
No
Raised BMI?
Yes
No
Sequence of events
Bag Mask Ventilation
Easy
With Oropharyngeal Airway
With Nasal Airway
Two Person Technique
Unsuccessful
Attempt 1
Device Used
Comments
Success
Unsuccessful
Attempt 2
Device Used
Comments
Success
Unsuccessful
Attempt 3
Device Used
Comments
Success
Unsuccessful
Further Comments
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