Page 153 - JSOM Fall 2020

APPENDIX D: SUPRAGLOTTIC AIRWAY PLACEMENT

SUPRAGLOTTIC AIRWAY (SGA) PLACEMENT • Confirm placement with ventilation and auscultation
CHECKLIST over epigastrium, then bilaterally over chest, left lung
• Open airway manually, measure and insert simple air- then right lung. Get a second practitioner to double
way adjunct (NPA or OPA). check and verify in sounds are questionable or cannot
• Ventilate patient with bag-valve-mask (BVM) (attach otherwise auscultate.
supplemental oxygen, if available). • Verify proper SGA placement by secondary confirma-
• If ventilations insufficient, or the patient is clearly un- tion such as capnography/capnometry or colorimetric
conscious and not breathing adequately, prepare for device.
supraglottic airway insertion. Inspect SGA to ensure • Place orogastric tube and decompress stomach if avail-
appropriate size. Lubricate airway to facilitate passage. able, and compatible with SGA device (has a port spe-
Cricothyroidotomy kit should be prepared for use if cifically for OGT placement).
SGA fails.
• Follow MSMAID and for induction, use ketamine (1– SGA Size Chart
2mg/kg IV/IO or 3–4mg/kg IM) if time permits and the Estimated patient size LMA King LT*
recommended medications are available. Neonates/infants (up to 5kg) 1 0
Infants 5–10 kg 1.5 1
INSERTING THE AIRWAY
• Properly position head in a neutral or “sniffing” po- Infants/children 10–20kg 2 2
sition (neck extended, as on a pillow or small blanket Children 20–30kg 2.5 2.5
while lying flat) and open airway. Children 30–50kg 3 3*
• Remove oropharyngeal airway (OPA) if previously Adults 50–70kg 4 4*
placed. Adults 70–100kg 5 5*
• Insert device to proper depth (may adjust later if need Adults > 100kg 6
for improved ventilation).
• Inflate cuff, if applicable; inflate as per device-specific
volume instructions and immediately remove syringe.

APPENDIX E: CRICOTHYROIDOTOMY PROCEDURE CHECKLIST

PREPARE PATIENT 5. Open and maintain membrane incision with tracheal hook
1. Pre-oxygenate patient if possible. (or curved hemostat, bougie, or blunt end of scalpel).
2. Inspect/assemble/test equipment for cricothyroidotomy. 6. Insert endotracheal/tracheostomy tube into opening and
3. Prepare site with alcohol and betadine or chlorhexadine direct tube caudad into trachea until the balloon is just
(Chlora-prep). inside the airway.
4. Follow MSMAID and for induction, use ketamine (1mg/kg 7. Inflate cuff and detach syringe (palpate bulb to ensure it is
IV/IO or 3–4mg/kg IM) if time permits and the medication not underinflated or overinflated).
is available. 8. Maintain control of tube at all times to prevent
dislodgement.
For awake cricothyrotomy: Explain procedure to patient; *Use
local anesthesia: lidocaine (1% or 2%), bupivacaine (0.25%, 9. Attach waveform capnography, or capnometry, or colori-
0.5%, or 1%); local through planned incision area AND ap- metric device to confirm proper placement of tube.
prox. 1–2mL through cricothyroid membrane 10. Being careful not to dislodge the tube, attach BVM with
PEEP and further check placement (epigastric and bilat-
PERFORM PROCEDURE eral chest) and adequacy of bilateral insufflation of lungs.
1. Stabilize thyroid cartilage and keep overlying skin taught. 11. Remove BVM (if sufficient respiratory effort), assess res-
Maintain control with hand until the membrane incision is pirations for adequacy (rate, rhythm, and quality), assist
secured (see step 8). ventilations if needed.
2. Locate cricothyroid membrane (Palpate for hyoid and tra- 12. Secure with sutures and tie with girth hitch passed around
cheal rings. If unsure or difficult landmarks, then measure the neck if time permits. As a stopgap, may use chest seal
three finger widths above sternal notch for adults.) or secure around the neck with tie, ensuring inflation bulb
3. Make vertical incision through the skin over cricothyroid does not get caught.
membrane. 13. Consider placing NG/OG tube if available.
4. Make horizontal incision through cricothyroid membrane,
then immediately:

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