airway devices without visualization of vocal cords LO5

airway adjuncts

after manually opening unresponsive patient airway and using suction an artificial airway adjunct can be inserted to maintain open passage

• NOT SUBSTITUTE FOR PROPER HEAD POSITIONING

oropharyngeal airway OPA

curved hard plastic device that fits over back of tongue with tip in posterior pharynx

• holds the tongue away from posterior pharyngeal wall

• makes bagging easier

• prevents patient from biting tracheal tuve

indications

• unresponsive

• snoring, gurgling, grunting

• breathing or not

• no gag reflex

  • if patient gags during insertion remove and prepare suction

contraindications

• responsive

• gag reflex present

insertion:

1. get suction ready

2. measure from corner of mouth to angle of jaw

3. turn backwards and run along hard palate

4. once on soft palate rotate 180 degrees

5. maintain head position

nasopharyngeal airway NPA

used when LOC is higher than OPA and has gag reflex

soft rubber tube inserted through nose into posterior pharynx behind the tongue

• lubricate before inserting

• never force during insertion

indications:

• unresponsive

• altered mental status

• gag reflex present

contraindications

• trauma to nose

• suspected skull fracture

insertion:

1. get suction ready

2. measure to pinky finger and lubricate

3. measure from nostril to ear

4. run bevel along septum until feel the curve

5. straighten out and push the rest of the way in

can be suctioned through

the king LT airway

has 2 inflatable cuffs, 1 seals off the esophagus, 1 seals off the oropharynx

can be used to provide positive pressure ventilation

• can insert tracheal tube through king LT airway

indications:

• alternative to bag mask ventilation when a rescue device is needed for a failed intubation attempt

• failure to protect airway

• cardiac arrest

contraindications:

• intact gag reflex

• vomiting

• know esophageal disease

• ingestion of caustic substance

• RODS

  • restrictive mouth opening

  • obstruction

  • distorted airway

  • stiff lung or C spine

balloon may push epiglottis over glottic opening

• gently withdraw without deflating until ventilation becomes easier

prolonged insertion can cause necrosis of esophagus

insertion:

1. preoxygenate patient and get suction ready

2. lubricate back side and avoid opening

3. get tube holder ready

4. open mouth wider, insert at 45 degree angle until past hard palette, then bring midline

5. insert until you feel resistance or until hub is at lips or teeth

6. insert air

7. ventilate patient

8. listen to chest for equal lung sounds

9. secure

10. continue ventilation 1 breath every 6 seconds

laryngeal mask airway

opening is positioned at the glottic opening, the tip in the proximal esophagus

indications:

• alternative to bag when patient cannot be intubated

• require high pulmonary pressure

  • COPD or heart failure

contraindications:

• morbid obesity

• pregnant

• hiatal hernia

does not prevent aspiration

monitor for upper airway swelling

igel

used when patient cannot protect their own airway

• apnea

1. preoxygenate the patient and get suction ready

2. elevate head so ear and sternum are level

3. lubricate back but avoid opening

4. prep holder so its equal on both sides of neck

5. insert and push until teeth are on bite block

6. ventilate with bag valve looking for chest rise

7. auscultate chest and listen for equal breath sounds L and R

8. secure device with neckstrap

9. reassess every 10 minutes or upon movement

contraindications:

• caustic substances

• esophageal conditions

• gag reflex present

combitube

multilumen airway device with long tube inserted blindly into the airway

indications:

• deeply unresponsive

• no gag reflex

• tracheal intubation not possible

• between 1.5-2m tall

contraindications

• less than 16

• esophageal trauma

• ingestion of caustic substance

• alcoholism

main advantage is it works both in esophagus or trachea