Page 39 - PJ MED OPS Handbook 8th Ed

Nasopharyngeal Airway (NPA)

For use on unresponsive casualties without evidence of basilar skull fracture or significant mid-face
trauma. NPA is the preferred initial airway adjunct. Never force the airway. If the patient does not
allow it to remain in place leave it out. This means their gag reflex is intact.
1. Lubricate with water soluble lubricant or the patient’s saliva.
2. Insert the airway through the right nostril, direct it straight back, not up, advance into the pos-
terior pharynx.
3. If unable to insert through the right nostril, attempt to place through the left nostril.

PJ PEARL:
• Keep a 6 inch piece of bougie with the NPAs to ream out the airway in blast patients PRN.
There have been cases of patients in blasts who have had dirt and debris impacted in their
nasal passages, as well as the trachea while attempting surgical airways. Keep full length
bougie with intubation gear.

Supraglottic airway (SGA) devices
1. I-gel – no cuffs to inflate. Preferred in aeromedical evacuation
2. LMA Supreme – one cuff to inflate

CAUTION: SGA’s are not definitive airways and thus require constant monitoring for displace-
ment including visual check of device, O2 saturation, capnography and chest rise and fall and
breath sounds. They should be adequately stabilized, and carefully managed during patient
movement.

Endotracheal Tube (ETT) �ntubation
For Protection of the Airway and/or Means of Ventilation In The Apneic Patient

Equipment:
1. Endotracheal tube with stylet, cuff checked for leaks (size 7.0–7.5–8.0 for adult)
2. Laryngoscope (check operation of blade, bulb and batteries)
3. BVM
4. Suction
5. Capnometer and Pulse oximeter
6. Syringe to inflate cuff and tape or other means of securing the ETT once placed
7. Elastic gum bougie
8. Rescue devices – SGA and cric kit readily available and prepared for use
Procedure:
1. Pre-oxygenate patient with 100% oxygen for several minutes prior to intubation, if available.
2. Assemble and test equipment while patient is being pre-oxygenated:
a. Inflate cuff of ETT with 5–10cc of air and check for leaks. Remove air from cuff leaving syringe
attached to tube. Insert stylet into ETT ensuring it does not protrude past the distal end of the
ETT. Ensure that the stylet slides out the top of the ETT easily.

Chapter 6. Surgical and Medical Procedures n 37