3-3-2 Rule


4.6 out of 5 (223 Reviews)



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Start Date

1 Sep 2023

Last Review Date

1 Sep 2023

Expiration Date

31 Aug 2026

Estimated Time To Finish

60 Minutes

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Activity Description

The procedure of endotracheal intubation plays an important role in maintaining a patient's airway in various clinical scenarios, such as surgeries and critical care. However, this process can be challenging in certain patients due to anatomical variations, commonly referred to as 'difficult airways.' Clinicians can utilize the 3-3-2 rule as a predictive tool to identify and prepare for these challenging scenarios in advance to minimize complications. The 3-3-2 rule involves measuring 3 different distances in the patient's neck using the clinician's fingers. These measurements aid in predicting the ease or difficulty of intubation. Additional tools such as the LEMON scale and the Mallampati scoring system also play a valuable role in the evaluation of the airway. This activity provides an overview of the procedures and techniques involved in endotracheal intubation, with a particular emphasis on the application of the 3-3-2 rule. It also highlights the role of the interprofessional team in efficiently managing patients who require intubation.

Target Audience

This activity has been designed to meet the educational needs of physicians, physician associates, nurses, pharmacists, and nurse practitioners.

Learning Objectives

At the conclusion of this activity, the learner will be better able to:

  • Screen patients with difficult airways using the 3-3-2 rule to promptly recognize individuals who may require special consideration and preparation for airway management.
  • Differentiate airway classes using the Mallampati scoring system to assess the visibility of specific anatomical structures during a mouth-wide-open examination.
  • Evaluate for airway obstruction as part of the LEMON scale to stratify patients based on their risk of difficult airway.
  • Collaborate with anesthesiologists, surgeons, and other relevant healthcare professionals to develop comprehensive airway management plans based on the results of the 3-3-2 rule assessment.


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Continuing Education Accreditation Information

In support of improving patient care, StatPearls, LLC is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.


Physicians and Physician Associates: StatPearls, LLC designates this enduring material for a maximum of 1.00 AMA PRA Category 1 Credit(s)TM. Physicians and PAs should only claim credit commensurate with the extent of their participation in the activity.

American Board of Anesthesiology: This activity contributes to the CME component of the American Board of Anesthesiology’s redesigned Maintenance of Certification in AnesthesiologyTM (MOCA®) program, known as MOCA 2.0®. Please consult the ABA website, www.theABA.org, for a list of all MOCA 2.0 requirements.

American Board of Internal Medicine: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.00 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

American Board of Otolaryngology–Head and Neck Surgery: Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn their required annual part II self-assessment credit in the American Board of Otolaryngology–Head and Neck Surgery’s Continuing Certification program (formerly known as MOC). It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of recognizing participation.

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American Board of Surgery: Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn credit toward the CME and Self-Assessment requirement(s) of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

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Deborah Z. on 1/6/2021

Alvar D. on 1/27/2021

Regina B. on 2/3/2021

Darcey A. on 2/13/2021

very good review

NASAR S. on 3/9/2021

Bhupendra M. on 4/27/2021

Sandeep S. on 5/8/2021

Edward C. on 5/31/2021

Excellent topic!

Antonio R. on 1/15/2023

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Rene G. on 12/28/2021

Good additions to the traditional airway exam. Thanks. One question is weird, where an anesthetist tries to intubate an adult female using 100 mcg of fentanyl. I know no anesthetist who would attempt intubation with such an inadequate dose of medication. Seems odd.

Androcles L. on 12/28/2021

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SREEDEVI Y. on 1/1/2022

Debra F. on 1/3/2022

I found STATPEARLS a good resource till now (I have read only one subtopic by now after joining) for my goals of passing USMLE with highest percentile and EPIC with high credits.

DR. SCIDDHARTHA K. on 1/4/2022

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Brian L. on 9/16/2022

illustrations and review of the upper lip bite test which Cochrane analysis indicates is likely the most useful should be included

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on 12/6/2022

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matthew r. on 1/12/2023

good value

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larry m. on 2/25/2023

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MENGTING D. on 4/2/2023

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VIJAY G. on 6/29/2023

Mary C. on 6/29/2023

Pictures/diagrams say a thousand words. Why none for this lesson?

Qefli N. on 7/4/2023

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Kenneth K. on 9/9/2023

on 9/11/2023

Stop with evaluations

Timothy R. on 9/14/2023

Larry V. on 9/15/2023

Very clearly articulated article

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