Report On An Innovation In Ambulance Practice Biology Essay

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This single-use device combines the finest features of all previous LMA airways and is the most advanced airway available in the world today. The ability to swiftly secure the airway and instantaneously carry out ventilations is of immense value in maintaining cardiac output during cardiopulmonary resuscitation. With its ingenious curve design for easy insertion, a built-in bite-block, a customized cuff to improve the seal and a drainage tube to provide a conduit for regurgitated fluid and gastric tube placement, LMA Supreme, leaves its competitors behind.

All the required clinical evidence and a new Clinical practice guideline (CPG) are attached to this proposal, for your perusal. Thank you for considering my request.

Yours faithfully,

Airway management is a vital part of treating the injured or critically ill patient and improvements in practice should be actively sought on a continued basis. One such area is the Laryngeal Mask Airway (LMA). "The LMA is a ground-breaking supraglottic airway management device. Since its commercial introduction in 1988, the LMA airway has been used in over two hundred million patients for routine and emergency procedures "(Goldmann, 2006, p.2). The standard LMA is "not an ideal airway device because the low-pressure seal may be inadequate for positive pressure ventilation, and it does not protect the lungs from gastric contents regurgitated into the pharynx" (Yildiz, Solak & Toker, 2007, p.3). LMA Supreme, as outlined by my proposal, heralds the new gold standard in airway management and has been available since April 2007. The LMA Supreme is a single-use, latex-free advance form of laryngeal mask airway which also includes gastric access (Colas & Martin, 2006).

LMA Supreme's design was inspired by observations made during two decades of clinical use of other LMA devices worldwide (Strube, 2009). The LMA Supreme provides access to the respiratory and separates it from the digestive tract. One of its main features is a gastric port for enabling blind insertion of standard gastric tubes into the stomach and rapid decompression of the abdomen (Eschertzhuber, Brimacombe, Hohlrieder & Keller, 2009). The LMA Supreme is also a single lumen airway and cannot invade the trachea and is softer than its predecessors so is less likely to exert high pressures against the pharyngeal mucosa (Williams, Patel & Ferguson, 2008). The LMA Supreme is much more suitable for Ambulance Victoria than any other laryngeal mask airway. The carefully tested design and subtle refinements in the mask make correct placement easy. With its verifiable placement and integrated drain tube; the LMA Supreme would make managing pre-hospital airway emergencies effortless.

Furthermore, the anatomically shaped airway tube is configured to permit paramedics an easy and reliable insertion without the need for placing fingers in the patient's mouth or requiring an introducer. The grooves in the tube are intended to prevent airway tube kinking which could lead to airway obstruction (Saini, Taxak & Das, 2009). Gone are the days of self-made bite blocks, LMA Supreme has a built-in bite-block which reduces the potential for airway obstruction or tube damage. This clever device, will save paramedics time and is definitely a step up from oropharyngeal airway or gauze used as bite blocks.

At present, there are no statistics documenting adverse effects with the LMA Supreme. "Until data becomes available, it should be assumed that a similar incidence and range of adverse events might occur with the LMA Supreme as occurs with other LMA airways. Review of published literature shows the incidence of aspiration with the LMA airway is low (0.012%), with the main causes being inappropriate patient selection and inadequate depth of anaesthesia. The incidence of sore throat following LMA airway use is approximately 13% and is usually mild and short lived "(Cook et al. 2009, p. 12). Many studies however, have shown positive outcomes, Ali, Canturk, Turkmen, Turgut, and Altan (2009) have concluded that The LMA Supreme is superior to the LMA Classic because of its ease of insertion with low cuff pressure and high oropharyngeal leakage pressure. Also, according to VanZundert and Brimacombe (2005) the LMA Supreme appears to bring together in a single device many of the best features of the ProSeal, Fastrach and Unique laryngeal mask airway devices.

The product is currently available in three sizes for patients weighing between 30 to 100 kilograms. This new device is more expensive but compared to the cost of a patient's life, the price justifies itself considering the potential benefit. Recent studies suggest that the LMA is an airway device that paramedics adapt to rapidly (Theiler, et al. 2009). Because LMA Supreme is even easier to insert than other LMA airways, extra education could be completed through personal development days provided by the ambulance service and refresher courses including manikin training may help skill retention. The introduction of LMA Supreme airway into ambulances will save precious time and provide patients; with optimal airway management.

In summary, strong evidence has shown that LMA Supreme offers important advantages over the Classic LMA for supraglottic airway management. LMA Supreme is easily and quickly inserted, provides ventilation at higher airway pressures, less airway stimulation, less throat irritation and reduces the risk of gastric aspiration and causes fewer stress responses. It is time for LMA Supreme to become an integrated part of Ambulance Victoria airway management as it combines the best features of all previous LMA airways in one device.

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Metropolitan Ambulance Service Rural Ambulance Victoria

Work Insertion of Laryngeal Mask Number

Instruction Airway Supreme WI: 2.2.15

Version 1 Sheet 1 of 2

16/3/10

Laryngeal Mask Airways Supreme (3 sizes), 50ml syringe COMPETEMCY

EQUIPMENT: ventilator device, stethoscope, adult manikin, ASSESSMENT

lubricant, transpore tape

ACTIVITY CRITICAL PERFORMANCE PASS FAIL

Utilises standard infection control precautions

1. Prepare patient. 1. Attempts manual airway clearance (Refer WI 2.2.1) ……… ………

2. Ensures airway is not obstructed. (Refer WI 2.1.8) ……… ………

3. Pre oxygenates the patient. ……… ………

2. Select and prepare 1. Select appropriate LMA size following estimation of ……… ………

LMA Supreme. patient size/weight. (Refer CPG)

2. Removes LMA Supreme from sterile packet. ……… ………

3. Removes red seal from cuff inlet. ……… ………

4. Attaches 50ml syringe. ……… ………

5. Holds the LMA Supreme by the tube. Move the ……… ………

connected syringe away from the device until the

inflation line is slightly stretched. Compress the

distal end of the device in between the index finger

and thumb while withdrawing air until a vacuum has

been obtained. Deflate the device until the tension in

the syringe indicates a vacuum has been created in the

mask. Keep the syringe under tension whilst rapidly

disconnecting it from the inflation port. This will

ensure the mask remains correctly deflated

6.Lubricate the posterior surface of the mask and ……… ………

airway tube just prior to insertion.

3. Prepare patient. 1. Stand behind or beside patient's head. ……… ………

2. Place the head in the neutral or slight "sniffing" position ……… ………

(Sniffing = extension of head + flexion of neck)

3. Assistant pulls down lower jaw to ensure opening ……… ………

of at least 3 finger breadths.

Metropolitan Ambulance Service Rural Ambulance Victoria

Work Insertion of Laryngeal Mask Number

Instruction Airway Supreme WI: 2.2.15

Version 1 Sheet 2 of 2

16/3/10

Laryngeal Mask Airways Supreme (3 sizes), 50ml syringe COMPETENCY

EQUIPMENT: ventilator device, stethoscope, adult manikin, ASSESSMENT

lubricant, transpore tape

ACTIVITY CRITICAL PERFORMANCE PASS FAIL

4. Insert LMA Supreme 1. Grasp the LMA Supreme firmly between the ……… ………

fingers and the thumb of the left hand, with

the distal aperture facing towards the tongue.

2. Press the distal tip against the inner aspect ……… ………

of the upper teeth or gums.

3. Slide inwards using a slightly diagonal ……… ………

approach (direct the tip away from the mid-line)

4. Continue to slide inwards rotating the hand in a ……… ………

circular motion so that the device follows the

curvature behind the tongue.

5. Resistance should be felt when the distal end ……… ………

of the device meets the upper oesophageal

sphincter.

6. Inflate the cuff with air until relevant ……… ………

intra-cuff pressure is reached.

Inflate with just enough air to achieve a seal

sufficient to permit ventilation without leaks.

7. Secure the LMA Supreme to patient's face ……… ………

using adhesive tape.

8. Does not use a Guedel airway; ……… ………

the device has an integral bite block

CANADATES NAME: ____________________________________

DATE:________________

Comments:……………………………………………………………………………………

…………………………………………………………………………………………………

Instructor (please print):…………………….

References

Ali, A., Canturk, S., Turkmen, A., Turgut, N., & Altan, A. (2009). Comparison of the laryngeal mask airway Supreme and laryngeal mask airway Classic in adults. European Journal Of Anaesthesiology, 26(12), 1010-1014. Retrieved March 17, 2010, from MEDLINE with Full Text database.

Ambulance Victoria. (2009) Clinical Practice Guidelines for Ambulance and MICA

Paramedics (Revised ed). Doncaster, Victoria: Ambulance Victoria.

Colas, M., & Martin, R. (2006). ProSeal laryngeal mask airway size and fiberoptic endotracheal intubation. Anesthesiology, 105(6), 1283. Retrieved March 17, 2010, from CINAHL with Full Text database

Cook, T., Gatward, J., Handel, J., Hardy, R., Thompson, C., Srivastava, R., et al. (2009). Evaluation of the LMA Supreme in 100 non-paralysed patients. Anaesthesia, 64(5), 555-562. Retrieved March 17, 2010, from CINAHL with Full Text database.

Eschertzhuber, S., Brimacombe, J., Hohlrieder, M., & Keller, C. (2009). The laryngeal mask airway Supreme--a single use laryngeal mask airway with an oesophageal vent. A randomised, cross-over study with the laryngeal mask airway ProSeal in paralysed, anaesthetised patients. Anaesthesia, 64(1), 79-83. Retrieved from March 13, 2010, CINAHL with Full Text database.

Goldmann, K. (2006). Recent developments in airway management of the paediatric patient. Current Opinion in Anaesthesiology (CINAHL), 19(3), 278-284. Retrieved March 21, 2010, from CINAHL with Full Text database.

Saini, S., Taxak, S., & Das, S. (2009). Prevention of aspiration by LMA ProSeal in laparoscopic surgery. Internet Journal of Anesthesiology, 20(1), 14. Retrieved from March 17, 2010, CINAHL with Full Text database.

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