Introducing the Fastrach-LMA. Prepared by Jim Medeiros, NREMT-P Regional Field Coordinator Lord Fairfax EMS Council
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1 Introducing the Fastrach-LMA Prepared by Jim Medeiros, NREMT-P Regional Field Coordinator Lord Fairfax EMS Council
2 Objectives Review Anatomy of the Upper Airway Review LFEMSC LMA Protocol Discuss Indications for LMA-Fastrach Discuss Insertion Steps for LMA-Fastrach Practice Insertion of LMA-Fastrach
3 Anatomy - Respiratory System Anatomy of the upper airway
4 Why the LMA? Endotracheal Intubation Remains the Choice for Emergency Airways Some patients are difficult to intubate Some patients have anatomical obstructions to direct visualizations Some patients have foreign bodies (blood, vomitus, etc.) obstructing visualization
5 Why the LMA? Too Many Patients in Arrest Brought to ER s Without Protected Airways LMA can be placed blindly by BLS and ALS Providers LMA provides some protection until intubation can be effectuated LMA-Fastrach allows blind placement of an ET tube by ALS Providers
6 Remember: LMA Fastrach is a TEMPORARY Airway, a rescue airway
7 Equipment Information LMA-Fastrach consists of the LMA with handle, a special intubation tube (size 7 in LFEMSC Region), and a stabilizer rod for use with the intubation tube. Reusable up to 40 times Must be autoclaved to sterilize (do not use sterilizing chemicals)
8 LMA Fastrach Components Stainless Steel Handle: Facilitates one-handed insertion and removal Eliminates need to place finger in mouth Allows adjustment of device position to enhance the seal against the larynx and optimize ventilation Valve Inflation Indicator Balloon Airway Tube: - Rigid, anatomically curved to optimize alignment with glottis - Can fit up to 8 mm ETT - Short enough to ensure passage of ETT cuff beyond vocal cords V-shaped ramp in aperture to guide ETT toward glottis Cuff Epiglottic elevating bar (EEB): Distal end unattached, to elevate the epiglottis when an ETT is passed through the aperture Inflation Line
9 Equipment Information Will be exchanged at Winchester Medical Center when a patient is brought in with one in place Plans call for exchange at other ER s in Region Initial price $200 through Lord Fairfax EMS Council (retail price over $400)
10 Indications for LMA-Fastrach Patient in Respiratory or Cardiac Arrest AND 2 Attempts at intubation failed Or, on attempted intubation visualization obscured by foreign bodies that cannot be effectively suctioned OR, for BLS providers, patient in Respiratory or Cardiac Arrest cannot otherwise maintain airway
11 Contraindications for LMA-Fastrach Conscious Patient Intact gag reflex
12 Steps for Insertion of LMA-Fastrach Ventilate patient with BVM 100% O2 for 1-2 minutes Suction as indicated Lubricate posterior mask tip Fully deflate cuff Leave head in neutral position
13 Steps for Insertion of LMA-Fastrach Hold by handle (handle is parallel to Pt chest) Position mask tip flat against hard palate Slide mask tip back along curvature of throat DO NOT LEVER HANDLE
14 Steps for Insertion of LMA-Fastrach Inflate cuff with up to 60 cc of air to achieve seal Place OP airway Ventilate with BVM
15 Steps for Insertion of LMA-Fastrach Auscultate for bilateral breath sounds Verify with capnometry After several minutes of adequate ventilation,als providers prepare to intubate
16 What it Really Looks Like on Insertion
17 Intubating Through the LMA Use only ET tube provided Preoxygenate, verify ET cuff integrity, lubricate distal tip of ETT Grip handle and draw larynx slightly forward
18 Intubating Through the LMA Pass ETT 1.5 cm past transverse (15 cm line) Inflate ETT cuff Verify silent epigastrium, presence of bilateral breath sounds. Use capnometry to verify placement
19 Grasp the handle firmly, and use it to draw the larynx forward 2-5 mm in a lifting action. This maneuver increases seal pressure and ensures optimal alignment of the axes of the trachea and the ETT. Chandy Maneuver:
20 Complications of LMA-Fastrach Bronchospasm, vomiting (verify no gag reflex) Trauma to larynx, epiglottis, arythenod s, pharyngeal wall (be gentle) Vocal cord paralysis (no levering/be gentle)
21 Removing the LMA-Fastrach LMA should ordinarily not be removed in the field Leave LMA in place after intubation Only remove LMA if patient regains gag reflex
22 Removing the LMA-Fastrach Be sure to deflate both LMA and ET cuffs first Have suction ready Turn patient to side and remove both devices in one smooth motion
23 For Further Information on LMA s On the Worldwide Web
24 Questions?
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