Alternative Airway Device (Supraglottic Airway)

Question 1

Steps 1 - 3

Answer 1

• Takes or verbalizes BSI precautions
• Opens the airway manually
• Elevates tongue, inserts simple adjunct (OPA or NPA)

Question 2

…No gag reflex is present and pt accepts adjunct

Steps 4 & 5

Answer 2

• Ventilates the pt immediately with BVM device unattached to O2
• Ventilates the pt with room air

Question 3

Examiner now informs candidate that ventilation is being performed without difficulty … (SPO2) is 85%
Steps 6 & 7

Answer 3

Attaches O2 reservoir to BVM device and connects to high-flow O2 regulator (12-15 lpm)
* Ventilates pt at a rate of 10 -12/min with appropriate volume

Question 4

After 30 seconds …The examiner must now take over ventilation
Steps 8 - 10

Answer 4

• Directs assistant to pre-oxygenate pt
• Checks/prepares supraglottic airway device
• Lubricates the distal tip of the device (may be verbalized)

Question 5

Examiner to remove OPA …

Steps 11 - 13

Answer 5

• Positions head properly
• Performs a tongue-jaw lift
• Inserts device to proper depth

Question 6

Step 14

Answer 6

Secures device in pt (inflates cuffs with proper volumes and immediately removes syringe or secures strap)

Question 7

Step 15

Answer 7

Ventilates pt and confirms proper ventilation (correct lumen and proper insertion depth) by auscultation bilaterally over lungs and over epigastrium

Question 8

Step 16

Answer 8

Adjusts ventilation as necessary (ventilates through additional lumen or slightly withdraws tube until ventilation is optimized)

Question 9

Step 17

Answer 9

Verifies proper tube placement by secondary confirmation such as capnography, capnometry, EDD or colorimetric device

Question 10

The examiner must now ask the candidate, “How would you know if you are delivering appropriate volumes with each ventilation?”
Steps 18 & 19

Answer 10

• Secures device or confirms that the device remains properly secured
• Ventilates pt at proper rate and volume while observing capnography/capnometry and pulse oximeter

Question 11

Critical 1 & 2

Answer 11

• Failure to initiate ventilations within 30 seconds after taking body substance isolation precautions or interrupts ventilations for greater than 30 seconds at any time
• Failure to take or verbalize BSI precautions

Question 12

Critical 3 - 5

Answer 12

• Failure to voice and ultimately provide high oxygen concentration (at least 85%)
• Failure to ventilate the patient at a rate of 10 – 12/minute
• Failure to provide adequate volumes per breath (maximum 2 errors/minute permissible)

Question 13

Critical 6 - 8

Answer 13

• Failure to pre-oxygenate patient prior to insertion of the supraglottic airway device
• Failure to insert the supraglottic airway device at a proper depth or location within 3 attempts
• Failure to inflate cuffs properly and immediately remove the syringe

Question 14

Critical 9 -11

Answer 14

• Failure to secure the strap (if present) prior to cuff inflation
• Failure to confirm that patient is being ventilated properly (correct lumen and proper insertion depth) by auscultation bilaterally over lungs and
  over epigastrium
• Insertion or use of any adjunct in a manner dangerous to the patient

Question 15

Critical 12 - 14

Answer 15

• Failure to manage the patient as a competent EMT
• Exhibits unacceptable affect with patient or other personnel
• Uses or orders a dangerous or inappropriate intervention