Intermediate aw devices

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INTERMEDIATE AIRWAY DEVICES

Paleerat Jariyakanjana, MDEmergency PhysicianNaresuan University

12 Sep 2012

THE LMA (LMA CLASSIC AND LMA UNIQUE)

Indications

rescue device for pediatric & adult emergency airway Mx

pt c brisk bleeding above the glottis or with difficult face mask ventilation owing to a beard, severe facial trauma, or obesity

Contraindications

relatively awake pt, especially those c a full stomach Decreased mouth opening severely distorted upper airway anatomy

Placement of the LMA

select the appropriate-sized LMA size 1 for neonates <5 kg – size 5 for adults >

100 kg


completely deflate the LMA cuff while pushing it posteriorly, so that it forms a smooth wedge shape without any wrinkles


Place a small amount of water-based lubricant onto the posterior surface of the LMA mask

best position: sniffing position


2 different techniques1. most common method: index finger insertion

technique

2. alternative method: thumb insertion technique

Index finger insertion technique

holding the LMA like a pen, c the index finger at the junction of the airway tube & the cuff


use the index finger to slide the LMA along the hard palate


Continue to push the LMA into the hypopharynx until resistance is felt.


Use the other hand to hold the proximal end of the LMA airway tube while removing your index finger


After the LMA is fully inserted, inflate the cuff

½ maximum cuff volume

Confirm: chest rise, breath sounds, and capnography


http://www.lmana.com/pwpcontrol.php?pwpID=6551

http://www.lmana.com/pwpcontrol.php?pwpID=6551

Complications

aspiration of gastric contents & hypoxia

THE ESOPHAGEAL-TRACHEAL COMBITUBE

2 parallel lumens small distal cuff, large

proximal cuff

Blindly esophagus 90%,

trachea 10%

Indications

primary airway in patients who are unresponsive or in cardiac arrest

rescue ventilation after failed bag-mask ventilation or failed intubation

Contraindications

intact gag reflex<4 feet tallsuspected caustic poisonings or

proximal esophageal disorders

THE LARYNGEAL TUBE

isolate the glottis opening between an oropharyngeal cuff and an esophageal cuff

Like the Combitube, the King LT is designed for blind placement and has a large proximal cuff and small distal cuff.

Unlike the Combitube, the tip of the King LT is designed to be placed into the esophagus only.

The shape of the King LT and the size of the tip make it unlikely to be placed into the trachea.

Indications~Combitube

Contraindicationsrelatively: foreign body upper airway

obstruction

Placement of the King LT

1st step: choose the proper size King LT available only in adolescent and adult sizes size 3: yellow, 4-5 feet in height size 4: red, 5-6 feet in height size 5 designed for patients >6 feet in height.

Check the cuffs and then completely deflate them prior to placement

Lubricate the device with a water-based lubricant.

best patient position: sniffing position


Hold the LT at the connector with the dominant hand and hold the mouth open by grasping the chin with the nondominant hand.

Introduce the tip of the device into the corner of the mouth while rotating the tube 45°-90° so that the blue orientation line on the tube is touching the corner of the mouth.

Pass the tip of the device into the mouth and under the tongue.


As the tip passes under the base of the tongue, rotate the tube back to the midline so that the blue orientation line faces the ceiling.

advance the King LT until the connector is aligned with the teeth

Inflate the cuffs with the minimum volume necessary to create a good seal.

Ventilate with a bag-valve system and confirm placement with chest rise, breath sounds, and capnography.

Complications

not extensively documentedmost serious potential complication:

tracheal placementImproper placement

Reference

Clinical procedures in emergency medicine, 5th edition

ANY QUESTIONS?

Intermediate aw devices

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