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Supraglottic Airway Medical Directive – AUXILIARY

An Advanced Care Paramedic may provide the treatment prescribed in this Medical Directive if authorized.

Indications

Need for ventilatory assistance or airway control;
AND
Other airway management is ineffective.

Conditions

Supraglottic Airway
Age N/A
LOA GCS = 3
HR N/A
RR N/A
SBP N/A
Other Absent gag reflex

Contraindications

Supraglottic Airway
Active vomiting
Inability to clear the airway
Airway edema
Stridor
Caustic ingestion

Treatment

Consider supraglotttic airway insertion
The maximum number of supraglottic airway insertion attempts is 2.
Confirm supraglottic airway placement
Method Method
Primary Secondary
ETCO2 (Waveform capnography) ETCO2 (Non-waveform device)
  Auscultation
  Chest rise

Clinical Considerations

An attempt at supraglottic airway insertion is defined as the insertion of the supraglottic airway into the mouth.

Confirmation of supraglottic airway must use ETCO2 (Waveform capnography). If waveform capnography is not available or is not working, then at least 2 secondary methods must be used.

Supraglottic Airway Device – King LT

  • Refer to the Supraglottic Airway Medical Directive for indications, conditions and contraindications.
  • Pre-oxygenate the patient for 30-60 seconds.
  • Check the tube cuff to ensure there are no leaks
  • Ensure that the 15mm adaptor is securely seated on the SGA.
  • Hold the King LT at the connector with dominant hand.
  • With non-dominant hand, open mouth and perform chin lift.
  • Using a lateral type approach, introduce tip of device into airway.
  • Advance the tip. As it passes the base of the tongue, rotate the device so the blue orientation line is in the midline position of the mouth.
  • Advance tube until base of connector is in line with teeth or gums.
  • Inflate device with appropriate volume of air for the size of SGA selected.
  • Attach BVM and assess for adequate ventilation.
  • If SGA has been inserted too deep, gently withdraw the tube untiladequate ventilation is achieved.
  • If SGA has been inserted too shallow, deflate the cuff and gently advance the tube until properly seated, reinflate cuff and assess for adequate ventilation.
  • Adjust inflation volume, if necessary and secure device.

INFLATION VOLUMES AND SIZING CHART

  Size
#2#2.5#3#4#5
Patient Criteria 35-45 in 41-51 in 4-5 feet 5-6 feet > 6 feet
90-115 cm 105-130 cm 122-155 cm 155-180 cm > 180 cm
Volume Max 35 mL Max 45 mL 45-60 ml 60-80 ml 70-90 ml

Immediately after insertion, correct tube placement must be confirmed.

Primary Method Secondary Method
ETCO2 Waveform capnography ETCO2 (Non-wavveform device)
Auscultation
Chest rise

Consideration:

Confirmation of supraglottic airways must use ETCO2 (waveform capnography). If waveform capnography is not availbable or is not working, then at least two secondary methods must be used.

Contact

Ministry of Health and Long-Term Care
5700 Yonge Street, 6th Floor
Toronto, ON M2M 4K5

416-327-7900

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