LEMON SCORE: A TOOL TO PREDICT DIFFICULT AIRWAY IN ED IN INDIAN SETTING.

Abstract

Background: Airway management is a critical need in many acutely ill and injured patients. Inadequate delivery of oxygen to brain and other vital structures is the quickest killer. Emergency airway management is the major key for successful resuscitation in ED. Emergency medicine is an emerging branch in India at present and no research study has been conducted to evaluate difficult airway prediction score. Hence this study aimed to find the use of LEMON score as a tool to predict difficult airway in our ED. Methods: All the patients requiring invasive mechanical ventilation with age >12 years, not admitted outside and admitted to the emergency medicine department from July 2017 to September 2019 were included in our study.  A total of 67 patients required invasive ventilation and were assessed by LEMON score for difficult intubation. This score is related to number of attempts required and Cormack lehane class of laryngoscopic view while intubation. Results: In the “LOOK EXTERNALLY” the most common finding was edentulous mouth with occurrence of 26.87%. In ‘EVALUATE’ component the most common difficulty was 2-3-2. In MALLAMPATI CLASS 56.71% were class I, 39.39% were class II. In OBSTRUCTION component of LEMON, 98.51% had no obstruction. In NECK MOBILITY component we found that 85.1% subjects had mobile neck and only 15.15% subjects had restricted neck mobility. We observed that the LEMON score is 60% sensitive and 96.15% specific to predict difficult airway. The positive predictive value was 83.33%. Conclusion: This tool can reduce the chance of unexpectedly encountering difficult airway.