Raven EMS Education Program ManualAirway LMA Evaluation Form
Date:
Student name:
Evaluator name:
Steps:
Take BSI precautions.
Open the airway: head tilt–chin lift or jaw-thrust maneuver.
Insert the OPA or NPA adjunct.
Ventilate the patient immediately with the bag-mask device unattached to oxygen at one breath every 3–5 seconds (12–20 breaths/min).
Attach the bag-mask device to high-flow oxygen at 15–25 L/min.
Ventilate the patient at a rate of one breath every 5–6 seconds (10–12 breaths/min) for at least 30 seconds.
Direct your partner to continue proper ventilation and to pre-oxygenate the patient.
Attach SpO2 and maintain at ≥94%.
Select and prepare the appropriate LMA based on the patient’s height and weight.
Lubricate the distal end of the device.
Position the patient’s head properly.
Instruct your partner to prepare for airway insertion, remove the OPA, and provide a 30-second time count.
Insert the LMA into the mouth and advance it to the appropriate depth.
Attach the bag-mask device to the tubing and ventilate the patient at one breath every 6 seconds.
Confirm proper placement by auscultating for negative epigastric sounds and positive bilateral lung sounds at the fourth to fifth ICS mid-axillary and seeing good chest rise. If the initial airway placement is unsuccessful, immediately deflate the cuff and prepare to suction; oxygenate the patient for a minimum of 30 seconds before reattempting advanced airway insertion.
Secure the LMA to the patient with a tube tamer or tape.
Continue to reassess the patient and interventions.
Dispose of all equipment properly.
Continue to reassess the patient and interventions.
Accepts evaluation and criticism professionally.
Shows willingness to learn or asks appropriate questions.
Interacts with simulated patient and other personnel in a professional manner (ie, uses appropriate name, explains procedures, maintains modesty, is courteous to crew, etc).
Passing criteria:
Pass: At least 70% (? of ?) successfully completed above. Currently at 0% completed.
Fail.
Fails to take BSI precautions prior to performing procedure.
Fails to assure adequate ventilation, provide high-concentration oxygen, and/or pre-oxygenate.
Fails to use appropriate-size LMA.
Fails to confirm correct placement of device.
Fails to perform an ongoing assessment.
Fails to assure proper tube placement by auscultation bilaterally and over the epigastrium.
Fails to place LMA within three attempts and/or performs skill in a dangerous/hazardous manner.
