Advanced Trauma Life Support ATLS Student Course Manual 2018

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APPENDIX G n Skills
shaft and orienting the LMA opening over the
patient’s tongue.
STEP 8. Pass the LMA behind the upper incisors,
keeping the shaft parallel to the patient’s
chest and the index finger pointing toward
the intubator.
STEP 9. Push the lubricated LMA into position
along the palatopharyngeal arch while
using the index finger to maintain pressure
on the tube and guide the LMA into
final position.
STEP 10. Inflate the cuff with the correct volume of air
(indicated on the shaft of the LMA).
STEP 11. Check placement of the LMA by applying
bag ventilation.
STEP 12. Confirm proper position by auscultation,
chest movement, and ideally verification of
CO 2
by capnography.
Insertion of Laryngeal
Tube Airway (ltA)
STEP 1. Ensure that adequate ventilation and
oxygenation are in progress and that
suctioning equipment is immediately
available in case the patient vomits.
STEP 2. Choose the correct size of LTA.
STEP 3. Inspect the LTA device to ensure it is
sterile and the lumen is clear and has no
visible damage.
STEP 4. Inflate the cuff of the LTA to check that it
does not leak. Then fully deflate the cuff.
STEP 5. Apply a water-soluble lubricant to
the beveled distal tip and posterior
aspect of the tube, taking care to avoid
introducing lubricant into or near the
ventilatory openings.
STEP 6. Have an assistant restrict motion of the
patient’s cervical spine.
STEP 7. Hold the LTA at the connector with the
dominant hand. With the nondominant
hand, open the mouth.
STEP 8. With the LTA rotated laterally 45 to 90
degrees, introduce the tip into the mouth
and advance it behind the base of the tongue.
STEP 9. Rotate the tube back to the midline as the tip
reaches the posterior wall of the pharynx.
STEP 10. Without excessive force, advance the LTA
until the base of the connector is aligned
with the patient’s teeth or gums.
STEP 11. Inflate the LTA cuffs to the minimum volume
necessary to seal the airway at the peak
ventilatory pressure used (just seal volume).
STEP 12. While gently bagging the patient to assess
ventilation, simultaneously withdraw the
airway until ventilation is easy and free
flowing (large tidal volume with minimal
airway pressure).
STEP 13. Reference marks are provided at the proximal
end of the LTA; when aligned with the
upper teeth, these marks indicate the depth
of insertion.
STEP 14. Confirm proper position by auscultation,
chest movement, and ideally verification of
CO 2
by capnography.
STEP 15. Readjust cuff inflation to seal volume.
STEP 16. Secure LTA to patient using tape or other
accepted means. A bite block can also be
used, if desired.
oRAl endotRAcheal
intubation
STEP 1. Ensure that adequate ventilation and
oxygenation are in progress and that
suctioning equipment is immediately
available in case the patient vomits.
STEP 2. Choose the correctly sized endotracheal tube
(ETT).
STEP 3. Inspect the ETT to ensure it is sterile and has
no visible damage. Check that the lumen
is clear.
STEP 4. Inflate the cuff of the ETT to check that it
does not leak.
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