ALS course documents

Airway management skill station

Key learning outcomes By the end of this session the candidate will:

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Show competency and confidence in the principles of establishing and maintaining a patent airway and providing adequate ventilation in an airway training manikin

Understand the complications and contraindications for each of the techniques taught

Instructor information Candidates should be advised that the skills taught in this section are subject to continuous assessment. At least one ERC ALS Instructor, and one other member of faculty, who is either a full Instructor or an Instructor Candidate, must supervise the skill station. Candidates must demonstrate competency in airway management. The instructor should:

Assess the ability of all candidates to maintain an airway and achieve effective ventilation of a manikin measured against predetermined competencies

Demonstrate the use of pocket mask ventilation (all candidates attending an ALS course should already be competent in this technique)

Enable all candidates to receive instruction in and the opportunity to practice insertion of an appropriate supraglottic airway device and ventilate a manikin using the device

Only when appropriate, and where time permits, allow candidates the opportunity to discuss the indications for and/or observe further advanced airway management and ventilation techniques e.g. tracheal intubation, emergency cricothyroidotomy

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This skill station is divided into three sections; the first two are compulsory for all candidates. 1. All candidates must receive practical instruction and undergo continuous assessment of their competency in the following: Recognition of the signs of airway obstruction Basic manoeuvres to relieve airway obstruction Head tilt / chin lift Jaw thrust

Insertion of airway adjuncts Oropharyngeal (Guedel) airway Nasopharyngeal airway

The indication for, and correct use of, suction equipment Ventilation using a self-inflating bag-mask with supplementary oxygen and reservoir, two-person technique

2.

All candidates must receive instruction and undergo continuous assessment in, and be allowed to practise: Insertion of and ventilation via an appropriate supraglottic airway e.g.

laryngeal mask airway (LMA), laryngeal tube (LT), I-Gel. Completion of a continuous assessment form is unnecessary for candidates who learn and demonstrate the above skills successfully. A form should be completed for those candidates who need remedial support and for those who do not meet the continuous assessment criteria for airway management. This will provide a definite record of progress.

3.

If appropriate, and in addition to the above skills, all candidates should be offered a practical demonstration and have the opportunity to discuss the indication for further advanced airway techniques including: Tracheal intubation Emergency cricothyroidotomy

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Instructor information

The practical skills of airway management and ventilation should be taught around a simple simulation. In order not to confuse the candidates, this is best achieved by

simulating a patient with respiratory compromise and subsequent respiratory arrest, thereby eliminating the need for chest compressions. The simulation can be broken down into 4 elements: Initial approach Airway assessment Recognition of signs of airway compromise and obstruction Basic airway opening manoeuvres

Arrival of basic adjuncts Use of suction Sizing and insertion of oropharyngeal and nasopharyngeal airway Demonstration by instructor of ventilation with expired air using a pocket mask

Arrival of additional equipment Assembly of self-inflating bag-mask, reservoir and supplementary oxygen Ventilation using two-person technique Confirmation of effective ventilation When all candidates have had their practice round, the Instructor should then introduce airway management using an appropriate supraglottic airway e.g. laryngeal mask airway (LMA). This can be achieved by expanding the simulation in such a way that ventilation using the bag and mask is becoming inadequate or difficult. For the LMA/LT this will require: Sizing and inspecting the LMA/LT Checking cuff integrity and lubricating Correctly inserting the LMA/LT and inflating the cuff Confirming ventilation using self-inflating bag,reservoir and supplementary oxygen

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Discussing the role of capnography

If an alternative supraglottic airway is used e.g. i-gel airway, then modifications appropriate to the device will need to be discussed and demonstrated.

When appropriate and if time permits, discussion of further advanced airway techniques may include the indication and practical demonstration of:

Tracheal intubation Emergency cricothyroidotomy Cricoid pressure Predicting and managing the difficult airway

Allow candidates to ask questions and reflect on the session content before terminating the session with a succinct review of all the major points covered.

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