PEM Playbook – Supraglottic Airways
- Oct 16th, 2020
- Tim Horeczko
Originally published at Pediatric Emergency Playbook on March 1, 2017 – Visit to listen to accompanying podcast. Reposted with permission.
Follow Dr. Tim Horeczko on twitter @EMTogether
First, learn to bag
Place a towel roll under the scapulae to align oral, pharyngeal, and tracheal axes:
Use airway adjuncts such as the oropharyngeal airway or a nasal trumpet.
Use the two-hand ventilation technique whenever possible:
(See Adventures in RSI for more)
for difficult bag-valve-mask ventilation or a difficult airway
(details in audio)
Pros: Best studied; sizes for all ages
Cons: Cannot intubate through aperture
Pros: Better ergonomics with updated design; bite bloc; port for decompression
Cons: Cannot pass appropriate-sized ETT through tube
King Laryngeal Tube
Pros: Little training needed; high success rate; single inflation port
Cons: Flexion of tube can impede ventilation or cause leaks; Update: King now makes a size 0 for infants < 5 kg (March, 2017)
Pros: Easy to place; can intubate through aperture
Cons: Not for neonates less than 4 kg
Pros: Molds more accurately to supraglottis; no need to inflate; good seal pressures
Cons: Cannot intubate through (without fiberoscopy)
• If you can bag the patient, you’re winning.
• If you have difficulty bagging, or anticipate or encounter a difficult airway, then don’t forget your friend the supraglottic airway (SGA).
• Ego is the enemy of safety: SGAs are simple, fast, and reliable.
• Just do it.
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Supraglottic Airway on WikEM
This post and podcast are dedicated to Tim Leeuwenburg, MBBS FRACGP FACRRM DRANZCOG DipANAES and Rich Levitan, MD, FACEP for helping to keep our minds — and our patients’ airways — open. You make us better doctors. Thank you.
Powered by #FOAMed — Tim Horeczko, MD, MSCR, FACEP, FAAP
Special thanks to Doug McDaniel, FP-C, for an update on King airways. Thanks, Doug!
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