APPENDIX D: SUPRAGLOTTIC AIRWAY PLACEMENT

Supraglottic Airway (SGA) Placement Checklist

- Open airway manually, measure and insert simple airway adjunct (NPA -or- OPA).
- Ventilate patient with bag‐valve‐mask (BVM) (attach supplemental oxygen, if available).
- If ventilations insufficient, or the patient is clearly unconscious and not breathing adequately, prepare for supraglottic airway insertion. Inspect SGA to ensure appropriate size. Lubricate airway to facilitate passage. Cricothyroidotomy kit should be prepared for use if SGA fails.
- Follow MSMAID and for induction, use ketamine (1-2 mg/kg IV/IO or 3-4mg/kg IM) if time permits and the recommended medications are available.

Inserting the Airway:

- Properly position head in a neutral or “sniffing” position (neck extended, as on a pillow or small blanket while lying flat) and open airway.
- Remove oropharyngeal airway (OPA) if previously placed.
- Insert device to proper depth (may adjust later if need for improved ventilation).
- Inflate cuff, if applicable; inflate as per device-specific volume instructions and immediately remove syringe.
- Confirm placement with ventilation and auscultation over epigastrium, then bilaterally over chest, left lung then right lung. Get a second practitioner to double check and verify in sounds are questionable or cannot otherwise auscultate.
- Verify proper SGA placement by secondary confirmation such as capnography/capnometry or colorimetric device.
- Place orogastric tube and decompress stomach if available, and compatible with SGA device (has a port specifically for OGT placement).