FBAO, LMA + IM

• FBAO stand for?

  foreign body airway obstruction
• what does the laryngoscope is used to what?

  decompress the tongue and visualise the back of the mouth
• what are the sizes of a laryngoscope and what size is used for who?

  size 2 = paediatric

  size 4 = adults
• what are the Magill forceps used for?

  to remove the foreign body, they have a serrated edge to allow for grip and the long angled handle ensures for adequate vision
• what is the first step in preparation?

  • wear PPE
  • patient in supine position in sniffing position
  • extent the head
  • select the correct size of laryngoscope
  • assemble the flange onto the handle as required
  • hold the laryngoscope in the left hand
  • open the blade so the light turns on
• what is the second step (insertion)?

  • insert the laryngoscope into the mouth behind the tongue
  • pull the blade forward, depressing the tongue so you can see the back of the mouth
• what is the third step (object removal)?

  • if you can see the object, use the Magill forceps in the right hand to grasp the object
  • if the foreign body removed, remove laryngoscope from the mouth and ventilate the patient using BVM
• what do you do if the object is not seen?

  • abandon procedure
  • perform 5 chest compressions to try and dislodge the object
  • re-check with laryngoscope to see if the object can be seen
  • if not, commence CPR
• what is an LMA (laryngeal mask airway)?

  • a supraglottic airway device that sits below the pharynx and above the glottis
  • the cuff provides a seal on the pharynx, which decreases the chance of gastric inflation and barotrauma
• what is the LMA size formula?

  (LMA size x 10) - 10
• how do you estimate paediatric weight?

  • under 1 = 5kg
  • 1-10 = (age in years + 4) x 2
  • 11-14 = age in years x 3
• what are the steps of the initial preparation?

  • appropriate PPE
  • clear the airway
  • sniffing position
  • confirm LMA is indicated
  • consider contraindications and cautions
• what are the steps involved with assembling the equipment?

  • LMA size
  • Thomas tube holder
  • alternative airway (OPA/NPA) in case of failed insertion
  • suction + oxygen
  • manual bag valve and mask
  • PEEP as appropriate
• what are the steps of testing the LMA?

  • open the LMA packet at one end and attach a syringe to the valve
  • cuff with be pre-filled, check integrity
  • deflate cuff
  • detach the syringe and ensure it is filled with air to correct amount
• what are the steps of insertion prep and insertion?

  • place Thomas tube holder in position (ready to secure)
  • ensure patient remains in the sniffing position
  • lubricate posterior surface of the cuff
  • extend the head as appropriate
  • open mouth
  • advance LMA over tongue
  • push the back of the LMA against the hard palate
  • maintain firm pressure until the cuff has disappeared and more resistance is felt.
• what are the steps involved with inflation of the LMA?

  • attach the pre-filled syringe to the valve
  • inflate cuff with appropriate amount of air
  • detach syringe
  • attach manual BVM and begin ventilating as appropriate
• what step comes after inflation?


  assess for chest rise - check for chest rise upon ventilation
• what comes after assessment of breathing?

  secure the LMA using a Thomas tube holder
• what can you do after completion?

  • connect a filter
  • connect EtCO2 if appropriate
  • connect Cobbs connecter if appropriate
  • connect PEEP if appropriate
  • connect BVM (required)
  • connect oxygen as appropriate
  • ventilate as appropriate
• what things should you be mindful of with an LMA?

  • gagging
  • LMA should stay secure
  • wary of significant vomiting (if they vomit put in a lateral position, remove the Thomas tube holder and gently remove the LMA)
  • maintain position of the airway
• what to do when you remove the LMA?

  • do not deflate the cuff
  • suction any secretions around the cuff
  • remove when the patient breathes out
  • fluids may be flicked out of the mouth as the LMA is removed
• what is an IM used for?


  administer medication into the musculature of a patient
• what are the preferred sites for an IM?

  • lateral thigh
  • deltoid muscle
• what are the usual needle sizes?

  • 23 gauge (25mm needle)
  • 25 gauge (16mm needle)
• what can an EMT administer through an IM?

  • adrenaline
  • glucagon
  • ondansetron
• what is step 1 of an IM?

  • wear PPE
  • consider indications, contraindications and cautions
  • select the injection site
  • explain procedure + gain consent
  • check patient allergies
• what is step 2 of an IM (assemble equipment)?

  • syringe (1ml or 3ml)
  • alcohol swab
  • drawing up the needle
  • medication to be administered
  • sharps container
  • administration needle
  • plaster
  • medication label as required
• what is step 3 of an IM (draw up the medication)?

  • attach drawing up needle to the syringe
  • drug check medication
  • open the ampoule
  • discard the lid
  • draw up the medication
  • discard the ampoule into the sharps container
  • expel air bubbles
  • check medication volume in the syringe is appropriate amount
  • label medicine if syringe is to be re-used
  • remove drawing up needle and discard into the sharps container
• what is step 1 of administration?

  • clean the injection site with an alcohol swab
  • place administration needle into syringe
  • remove cap
  • tension site using 'Z track' technique
  • warn patient of upcoming needle 'sharp scratch'
  • draw back (aspirate to confirm placement outside of vasculature)
  • slowly administer medication
  • throw the complete syringe and needle into the sharps container (single use)
• what is step 2 after administration (completion)?

  • apply plaster to the injection site as needed
  • apply pressure to the injection site if bleeding is present
  • appropriate documentation of medication, intervention (time administered, amount, route)
  • be mindful of allergic reactions
• what are some safety issues?

  • DO NOT recap a needle
  • state, verbally, "sharps out" or "sharps exposed"
  • wear covered shoes