Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX G n Skills
Part 1: Basic Airway Skills
Skills Included in this
Skill Station
••
Insertion of Nasopharyngeal Airway (NPA)
••
Safe Use of Suction
••
Insertion of Oropharyngeal Airway
and Reassessment
••
One-Person Bag-Mask Ventilation
••
Two-Person Bag-Mask Ventilation
Insertion of Nasopharyngeal
Airway (NPA)
Note: Do not use a nasopharygeal airway in a patient with
midface fractures or suspected basilar skull fracture.
STEP 1. Assess the nasal passages for any apparent
obstruction (e.g., polyps, fractures, or
hemorrhage).
STEP 2. Select the proper size of airway. Look at the
nostril diameter to determine the greatest
size that will pass easily through the nostril.
STEP 3. Lubricate the nasopharyngeal airway with a
water-soluble lubricant or tap water.
STEP 4. With the patient’s head in neutral
position, stand to the side of the patient.
Holding the NPA like a pencil, gently
insert the tip of the airway into the nostril
and direct it posteriorly and toward
the ear.
STEP 5. Gently insert the nasopharyngeal airway
through the nostril into the hypopharynx
with a slight rotating motion, until the
flange rests against the nostril. If during
insertion the NPA meets any resistance,
remove the NPA and attempt insertion
on the other side. If the NPA causes the
patient to cough or gag, slightly withdraw
the NPA to relieve the cough or gag and
then proceed.
STEP 6. Reassess the patient to ensure that the airway
is now patent.
Safe Use of Suction
STEP 1. Turn on the vacuum, selecting a midpoint
(150 mm Hg) rather than full vacuum (300
mm Hg).
STEP 2. Gently open the mouth, inspecting for bleeding,
lacerations or broken teeth. Look for the
presence of visible fluid, blood, or debris.
STEP 3. Gently place the suction catheter in the
oropharynx and nasopharynx, keeping the
suction device (Yankauer) tip in view at
all times.
Insertion of OrophARyngeal
Airway (opA) (airway cleAR)
STEP 1. Select the proper size of airway. A correctly
sized OPA device extends from the corner of
the patient’s mouth to the earlobe.
STEP 2. Open the patient’s mouth with the crossedfinger
(scissors) technique.
STEP 3. Insert a tongue blade on top of the patient’s
tongue and far enough back to depress the
tongue adequately. Be careful not to cause
the patient to gag.
STEP 4. Insert the airway posteriorly, gently sliding
the airway over the curvature of the tongue
until the device’s flange rests on top of the
patient’s lips. The device must not push the
tongue backward and block the airway. An
alternate technique for insertion, termed
the rotation method, involves inserting
the OPA upside down so its tip is facing the
roof of the patient’s mouth. As the airway
is inserted, it is rotated 180 degrees until
the flange comes to rest on the patient’s lips
and/or teeth. This maneuver should not be used
in children.
STEP 5. Remove the tongue blade.
STEP 6. Reassess the patient to ensure that the airway
is now patent.
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