RT Book, Section A1 Murray, Nate A1 Aziz, Michael A2 Hung, Orlando R. A2 Murphy, Michael F. SR Print(0) ID 1202477882 T1 Airway Management for a Patient with Upper Gastrointestinal Bleeding and an Anticipated Difficult Airway T2 Hung’s Management of the Difficult and Failed Airway, 4th Edition YR 2024 FD 2024 PB McGraw Hill PP New York, NY SN 9781264278329 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1202477882 RD 2024/10/09 AB A 46-year-old man with a history of nonalcoholic steatohepatitis (NASH) cirrhosis and prior upper gastrointestinal (GI) bleeding presents to the emergency department (ED) with acute onset of hematemesis and melena. His past medical history is significant for obesity with a body mass index of 38 kg·m−2, obstructive sleep apnea (OSA) for which he declined the use of noninvasive ventilation, diabetes mellitus, and hypertension. He was noted to have ascitic fluid on his most recent liver ultrasound but has never needed large-volume paracentesis. His vital signs demonstrate a sinus tachycardia with a rate of 108 beats per minute and blood pressure of 110/68. He is afebrile and has a mildly delayed peripheral capillary refill. On exam he is an obese man, appears as stated age, in mild distress, and somewhat drowsy. He has a thick neck with palpable, but not visible, laryngeal structures. He has mild retrognathia with a decreased thyromental distance. Examination of his mouth revealed intact dentition, Mallampati IV, and inability to bring the lower incisors above the upper vermillion border.