Advanced Trauma Life Support ATLS Student Course Manual 2018

AIRWAY MANAGEMENT 31
Oropharyngeal Airway
Oral airways are inserted into the mouth behind the
tongue. The preferred technique is to insert the oral
airway upside down, with its curved part directed
upward, until it touches the soft palate. At that point,
rotate the device 180 degrees, so the curve faces
downward, and slip it into place over the tongue
(n FIGURE 2-7; also see Oropharyngeal Airway Insertion
video on MyATLS mobile app).
Do not use this method in children, because rotating
the device can damage the mouth and pharynx. Instead,
use a tongue blade to depress the tongue and then insert
the device with its curved side down, taking care not to
push the tongue backward, which would block the airway.
Both of these techniques can induce gagging, vomiting,
and aspiration; therefore, use them with caution in
conscious patients. Patients who tolerate an oropharyngeal
airway are highly likely to require intubation. (See
Appendix G: Airway Skills.)
Extraglottic and Supraglottic Devices
The following extraglottic, or supraglottic, devices have
a role in managing patients who require an advanced
airway adjunct, but in whom intubation has failed or
is unlikely to succeed. They include laryngeal mask
airway, intubating laryngeal mask airway, laryngeal
tube airway, intubating laryngeal tube airway, and
multilumen esophageal airway.
Laryngeal Mask Airway and Intubating LMA
The laryngeal mask airway (LMA) and intubating
laryngeal mask airway (ILMA) have been shown to
be effective in the treatment of patients with difficult
airways, particularly if attempts at endotracheal
intubation or bag-mask ventilation have failed. An
example of an LMA appears in (n FIGURE 2-8). Note that
the LMA does not provide a definitive airway, and
proper placement of this device is difficult without
appropriate training.
The ILMA is an enhancement of the device that allows
for intubation through the LMA (see Laryngeal Mask
Airway video on MyATLS mobile app). When a patient
has an LMA or an ILMA in place on arrival in the ED,
clinicians must plan for a definitive airway.
Other devices that do not require cuff inflation, such
as the i-gel® supraglottic airway device, can be used in
place of an LMA if available (n FIGURE 2-9).
Laryngeal Tube Airway and Intubating LTA
A
The laryngeal tube airway (LTA) is an extraglottic
airway device with capabilities similar to those of
the LMA in providing successful patient ventilation
(n FIGURE 2-10). The ILTA is an evolution of the device
B
n FIGURE 2-7 Alternative Technique for Inserting Oral Airway.
A. Advanced In this Trauma technique, Life Support the for oral Doctors airway is inserted upside down until
Student Course Manual, 9e
the American soft College palate of Surgeons is encountered. B. The KB device is then rotated 180
Figure# 02.06AB
degrees Dragonfly Media and Group slipped into place over the tongue. Do not use this
09/19/2011
WC
method in children. Note: Motion of the cervical spine must be
restricted, but that maneuver is not shown NP in order to emphasize the
airway insertion technique.
Approved Changes needed Date
n FIGURE 2-8 Example of a laryngeal mask airway.
n BACK TO TABLE OF CONTENTS