What is the 3-3-2 rule for intubation?

What is the 3-3-2 rule for intubation?

Using the fingers held together, assess the distance from the hyoid bone to the chin (should be at least three fingers) and the distance from the thyroid cartilage to the floor of the mouth (at least two fingers). Any measurement that is less than 3-3-2 indicates potential difficulty with airway management.

What is Interincisor distance?

1. Mouth-opening ability. This is measured as the interincisor distance. A value of less than 4 cm has been proposed as an indicator of possible difficult intubation. Fibrous or bony temporomandibular joint ankylosis will absolutely diminish mouth opening.

What is a normal Thyromental distance?

A typical patient can place three fingers on the floor of the mandible between the mental angle and the neck near the hyoid bone. Normally this distance should measure close to 7 cm.

What is normal Thyromental distance?

What is a Class 3 airway?

If you only see a little room, usually just the soft palate and base of the uvula, that’s a Class 3. If all you see is the tongue and hard palate that’s a Class 4.

When to use the 3-3-2 rule in anesthesia?

For each consenting adult patient undergoing general anesthesia, preoperative patient characteristics and data regarding difficult airway assessments and airway outcomes were collected. The 3-3-2 rule, 3-3-1 rule and 3-3 rule were included in preoperative difficult airway assessments.

How is anesthesia reimbursement based on base units?

Payment for services that meet the definition of ‘personally performed’ is based on base units (as defined by CMS) and time in increments of 15-minute units. Time units are computed by dividing the reported anesthesia time by 15 minutes (17 minutes / 15 minutes = 1.13 units).

How to determine payment for anesthesia services?

Additionally, the formula used to determine payment for anesthesia services is unique to anesthesia. These rules and formula may be misunderstood or improperly applied.

Is the anesthesia CPT code unchanged for 2018?

For a list of base units assigned to anesthesia CPT codes for 2018, please refer to the 2018 Anesthesia Base Units by CPT Code on the CMS website. The anesthesia base units are unchanged for calendar years 2019 and 2020.

Helpful tips

What is the 3 3 2 rule for intubation?

What is the 3 3 2 rule for intubation?

Evaluate the 3-3-2 rule: This aspect of airway education involves three measurements — the distance between the upper and lower incisors, the distance between the hyoid bone and the chin, and the distance from the thyroid cartilage to the floor of the mouth.

How do you assess a difficult airway?

A large mandible can also attribute to a difficult airway by elongating the oral axis and impairing visualization of the vocal cords. The patient can also be asked to open their mouth while sitting upright to assess the extent to which the tongue prevents the visualization of the posterior pharynx.

What is the difficult airway algorithm?

The Difficult Airway Algorithm of the American Society of Anesthesiologists (ASA) was developed to guide clinicians in the management of the patient who is either predicted to have a difficult airway or whose airway cannot be adequately managed after induction of anesthesia (1).

What is the 332 rule?

(A) The patient can open his/her mouth sufficiently to admit three of his/her own fingers. (B) The distance between the mentum and the neck/mandible junction (near the hyoid bone) is equal to the width of three of the patient’s fingers.

What is Burp maneuver?

The BURP maneuver consists of the displacement of the thyroid cartilage dorsally so as to abut the larynx against the bodies of the cervical vertebrae, 2 cm cephalad until mild resistance is met, and 0.5-2.0 cm laterally to the right.

How do you RSI a patient?


  1. Plan.
  2. Preparation (drugs, equipment, people, place)
  3. Protect the cervical spine.
  4. Positioning (some do this after paralysis and induction)
  5. Preoxygenation.
  6. Pretreatment (optional; e.g. atropine, fentanyl and lignocaine)
  7. Paralysis and Induction.
  8. Placement with proof.

Which is an indicator of a difficult airway?

A reduction in space (<5 mm) between the C1 spinous process and the occiput, seen on a lateral neck radiograph taken in a neutral position, is recognized as an indicator of difficult intubation.

What can cause a difficult airway?

The incidence of the difficult airway characteristics was as follows: obesity (29%), short neck (22%), secretions (20%), small mandible (14%), blood present (13%), large tongue (11%), limited mouth opening (11%), vomit present (6%), airway edema (6%), cervical immobility (3%), and facial or neck trauma (1%).

How do you handle a difficult airway?

Noninvasive interventions intended to manage a difficult airway include, but are not limited to: (1) awake intubation, (2) video-assisted laryngoscopy, (3) intubating stylets or tube-changers, (4) SGA for ventilation (e.g., LMA, laryngeal tube), (5) SGA for intubation (e.g., ILMA), (6) rigid laryngoscopic blades of …

What causes a difficult airway?

The main factors implicated in difficult endotracheal intubation were poor dental condition in young patients, low Mallampati score and interincisor gap in middle-age patients, and high Mallampati score and cervical joint rigidity in elderly patients.

What causes Mallampati?

A Mallampati score of III or IV is typically indicative of a higher rate of obstruction in airway as a result of enlarged tonsils or adenoids and poor Myofunctional activity (swallowing pattern and tongue position at rest) and tongue-tie.

How do you do the BURP maneuver?

Applying backward, upward, rightward, and posterior pressure on the larynx (i.e., displacement of the larynx in the backward and upward directions with rightward pressure on the thyroid cartilage) is called the “BURP” maneuver and has been well described by Knill.