Please note content is for educational purposes only and procedures should not conducted based on this information. OSCEstop and authors take no responsibility for errors or for the use of any content.
Nasopharyngeal airway
Flexible rubber tube which goes through the nose and ends at base of tongue (an adjunct to help keep airway open)
An oxygen mask or bag-mask ventilation can be applied over the top if needed
Function: prevents tongue covering epiglottis in patients with reduced GCS. It is better tolerated than oropharyngeal airways in more alert patients.
Size: 6-7mm diameter for most adults; tube diameter should be similar to nostril size
Insertion technique:
Lubricate the nasopharyngeal airway with water-soluble jelly
Insert into the nostril (preferably right) horizontally along the floor of the nose with a slight twisting action (aim towards the back of the opposite eyeball)
Confirm airway patency
Oropharyngeal airway (Guedel)
Rigid plastic tube which sits along top of oral cavity and ends at base of tongue (an adjunct to help keep airway open)
An oxygen mask or bag-mask ventilation can be applied over the top if needed
Function: prevents tongue covering epiglottis in patients with reduced GCS
Size: should be similar to distance between the incisors and the angle of jaw; size 3 (orange) for medium adult
Insertion technique:
Ensure no foreign bodies in the mouth
Lubricate the oropharyngeal airway
Insert into the mouth upside-down (reduces risk of pushing tongue back) โ do not continue if patient gags
Once tip is around the hard-soft palate junction, rotate 180ห and advance the rest of the way
Confirm airway patency
Supraglottic airway (usually i-Gel)
Flexible plastic tube with a cuff on the end which sits over top of larynx. Provides some protection against aspiration but does not fully secure airway and can only withstand a small amount of positive pressure ventilation.
Can be attached to ventilation bag in respiratory arrest; or, during surgery, to ventilator which allows spontaneous ventilation ยฑ low-level positive pressure ventilation supplementation
Function:airway protection during anaesthetic for surgery (if no risk of aspiration and a muscle relaxant is not required); respiratory arrest; if endotracheal intubation is indicated but fails, or the clinician is not trained in intubation
Size: 4 (green) for average adult
Gather equipment
Equipment list
Supraglottic airway (usually i-gel)
Water-soluble lubricating jelly
Tape
Suction
Ventilation bag
Ventilation face mask (will be required if insertion fails)
Medications for awake patients (hypnotic and analgesia)
Insertion technique:
Give medications if required
Lubricate outer airway
Position patient โ neck flexed to 15ห, head extended on neck (i.e. chin anteriorly), no lateral deviation
Standing behind the patient, hold the tube like a pen and insert into the mouth (cuff opening inferiorly), sliding the outer cuff along the palate
Push back over tongue until it reaches the posterior pharyngeal wall
Apply pressure to force it backwards and downwards until it reaches the back of the hypopharynx
The teeth should be between the two black lines on the airway
Attach ventilation bag/machine and ventilate (~10 breaths/minute) with high concentration oxygen. Observe chest expansion and auscultate to confirm correct placement.
Consider applying end-tidal CO2 monitor to confirm placement and then secure with bandage or tape
Flexible plastic tube with cuff on end which sits inside the trachea (fully secures airway โ gold standard)
Attached to ventilation bag/machine
Function:ventilation during anaesthetic for surgery (if muscle relaxant is required, long case, abdominal surgery, or if head positioning may be required); if patient cannot protect their airway (GCS <8, aspiration risk, muscle relaxation); potential airway obstruction (airway burns, epiglottitis, neck haematoma); inadequate ventilation/oxygenation (e.g. COPD, head injury, acute respiratory distress syndrome)
Rapid sequence induction intubation = procedural variant using rapid anaesthetisation with cricoid pressure to prevent aspiration while airway is quickly secured โ used for patients at risk of aspiration, e.g. non-fasted patients
Size: 8mm diameter for men, 7mm diameter for women
Gather equipment
Equipment list
Laryngoscope (check size โ the blade should reach between the lips and larynx โ size 4 for most patients), turn on light
Medications for awake patients (hypnotic, analgesia and short-acting muscle relaxant)
Laryngoscope technique:
Give medications if required
Pre-oxygenate patient with high flow oxygen for 3-5 minutes
Position patient โ neck flexed to 15ห, head extended on neck (i.e. chin anteriorly), no lateral deviation
Stand behind the head of the patient
Open mouth and inspect: remove any dentures/debris, suction any secretions
Holding laryngoscope in left hand, insert it looking down its length
Passing the tongue
Slide down right side of mouth until the tonsils are seen
Now move it to the left to push the tongue centrally until the uvula is seen
Advance over the base of the tongue until the epiglottis is seen
Insertion technique:
Apply traction to the long axis of the laryngoscope handle (this lifts the epiglottis so that the V-shaped glottis can be seen)
Insert the endotracheal tube via the groove of the laryngoscope so that the cuff passes the vocal cords (male 22-24cm, female 20-22cm)
Remove laryngoscope and use syringe to inflate the tubeโs cuff with the minimum amount of air required for an effective seal
Attach ventilation bag/machine and ventilate (~10 breaths/minute) with high concentration oxygen. Observe chest expansion and auscultate to confirm correct placement.
Consider applying end-tidal CO2 monitor to confirm placement
Secure the endotracheal tube with tape
NB: if it takes more than 30 seconds, remove all equipment and ventilate patient with a bag-mask and high flow oxygen until ready to reattempt intubation.
Tracheostomy
Surgical hole made in trachea, through which a tracheostomy tube is passed
Attached to ventilation bag/machine
Function: a tracheostomy is performed for long-term ventilation in intensive care
NB: a needle or surgical cricothyroidotomy is different and is used in the emergency setting when an acute upper airway obstruction is preventing endotracheal intubation
Sedation, paralysis, ventilation
If a patient has had a muscle relaxant theyย needย to be ventilated
Otherwise the need for ventilation/supplementation of breathing depends on theย degreeย of sedation (a low amount of sedation can allow spontaneous ventilation)
Patients need to be sedated to a certain degree to allow intubation
A short-acting muscle relaxant helps endotracheal intubation
Comments are closed for this post.