Potential Hazards

In the emergency situation there may be very little time for a considered clinical assessment but even the briefest of glances may be sufficient to alert the wary practitioner to potential hazards.

An obese, bearded, immobilised trauma patient with facial injuries may challenge an expert.

Six features have been identified as likely to cause difficulty with BVM ventilation in elective patients [6,7]:

• Presence of a beard
• Lack of teeth
• Age>55
• BMI>30
• History of snoring
• Inability to protrude the mandible so that the lower incisors are anterior to the upper incisors

Elective patients who prove both difficult to ventilate and difficult to intubate have been noted to have the last three from the above list plus a history of sleep apnoea and/or a particularly thick or obese neck [6].