Category Archives: Supraglottic Airway

So, just to be perfectly clear, as I have heard this in a round-about way from a few sources... We are not to use high concentration/High Flow oxygen via a BVM with a VSA patient without inserting an SGA - so when treating a VSA pt, we go directly to the SGA without ever using an OPA or NGA, correct? And what are our options if the SGA fails after 2 attempts and we do not have any extra hands to ensure a tight seal on the BVM mask - do we ventilate at all, or just administer compressions and carry on?

When dealing with a patient who is VSA due to a complete foreign body airway obstruction, what is recommended in regards to ventilations and OPA use (during this COIVD-19 pandemic) since “inability to clear the airway” is a contraindication of SGA use.

In a previous response to a question, it was mentioned that the SGA is an effective way to create a closed system and reduce risk of aerosolization when ventilating. Would it then be reasonable to go directly to the SGA in the setting of VSAs, to further protect all those involved in the resuscitation from possible aerosolization with an OPA/BVM?

Questions regarding intubation. Should we be opting for aggressive airway management with intubation or SGA on VSA patients as well as severely obtunded non-asthmatic patients where patient presentation would allow? Should this take precedence over ACLS drugs during cardiac arrest? When intubated with inline filter in place are we permitted to BVM an normal rate?

Question: The latest Memo regarding oxygen delivery states "IN ALL CASES where adult patients require high concentration oxygen, use high-concentration/low flow masks with a hydrophobic submicron filter" and then later reads that high concentration oxygen be avoided unless SGA. The instructions for the FLO2MAX mask our service carries instructs you to set the oxygen flow-meter to 15lpm, or to level prescribed by a physician. What do you recommend we set the flow meter at if we use these masks?

Question: What is the best method to cover the King LT suction port? You mentioned this practice during your 2nd podcast.

Question: Why is SGA preferred over ETT during the pandemic? Will I be penalized if I have to intubate someone?

Question: Can a PCP insert a King LT in a non-VSA patient with a GCS of 3 under the direction of an ACP?

Question: I have a quick question on the PCP supraglottic airway medical directive. What is the rationale for the "must be VSA" condition on the directive for PCP, yet ACP's can use it as a back-up device for failed airway management. Would it not make more sense to make the conditions for PCP something like "Patient must have a GCS=3 and other airway management is inadequate or ineffective"?

The issue here could be two-fold. First, if BVM ventilation is ineffective as a PCP, there is nothing you can fall back on, whereas the ACP can use either ETI or a SGA as indicated. If this ineffective BVM situation occurs as a PCP and the patient is GCS=3, why can't we insert a SGA as a rescue device for ineffective BVM ventilation?

Secondly, with some new evidence beginning to show that SGA's may actually not be as great as we thought in VSA patients, is there a risk we could abandon them entirely from the PCP level, in essence "throwing the baby out with the bathwater" and abandoning a valuable device simply because the conditions for its use were restrictive.

Also, do you have any idea when the new revised BLS standards may be coming out from the MOHLTC? I'm hoping there are new evidence based oxygen therapy guidelines. Any thoughts? Thanks.

Question: In the ALS patient care standards it states that a Supraglottic Airway (King) is indicated when "Need for ventilatory assistance OR airway control AND Other airway management is inadequate or ineffective"

In the "un-controlled" world of EMS would it not be more effective to use a King over an oral airway after the first round of CPR is complete? The King allows for movement from the floor to stretcher with no worry about "losing" your airway. It also doesn't fall out as an oral airway will in the difficult situations/extrications we face in the field. The fear of gastric distention is also completely alleviated, making the King more effective. It would also allow for constant compressions, which is the best treatment for cardiac arrest patients in pre-hospital settings according to the Heart & Stroke. I have had many discussions with other paramedics and they seem to think that you can't use the King at all if you have an oral airway that is giving adequate control. So my question is, if you use the King on VSA patients, is it acceptable even if the oral airway will work (just not as adequately or effectively in my opinion)?