■ Advance the tube during inspiration.
■ If successful, there is usually associated coughing and/or stridor and cessa-
tion of vocalization.
■ Inflate cuff and confirm placement.
COMPLICATIONS
■ Epistaxis
■ Esophageal intubation
■ Sinusitis, turbinate damage
LARYNGEALMASKAIRWAY(LMA)
The LMA is available in the following sizes:
■ 1–3: Newborn to 30–50 kg child, in .5 increments
■ 4: 50–70 kg adult
■ 5: Larger adults
INDICATIONS
■ Rescue device for “can’t intubate” situations
CONTRAINDICATIONS
■ Significant oropharyngeal pathology, trauma, or bleeding.
PROCEDURE
■ Open airway via head tilt.
■ Insert LMA with opening facing the tongue and advance along the hard
palate until tip is well into hypopharynx.
■ Inflate cuff with 20–40 mL air (amount listed on device).
■ Forms seal around glottic opening
■ With the intubating LMA, an ET tube can be advanced through the lumen
of the LMA for blind tracheal intubation.
COMPLICATIONS
■ Aspiration
■ Limited utility in patients who require high pressures to ventilate (eg, obese,
severe asthma)
RETROGRADETRACHEALINTUBATION
INDICATION
■ Rescue device for “can’t intubate” situations
PROCEDURE
■ Via Seldinger technique place needle in cricothyroid membrane or a high
tracheal space.
■ Pass a wire through the needle until it emerges from the mouth. Remove
the needle and secure the percutaneous part of the wire with a hemostat.
■ Advance the ET tube over wire into trachea.
RESUSCITATIONEase of use and potential to
transition to a definitive
airway make the LMA useful
in the difficult airway but
doesn’t protect against
aspiration.