Newborn Life Support Provider Course Airway Station Guide to by monkey6

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									Newborn Life Support Provider Course Airway Station Guide to teaching the airway station using a modified 4-stage technique
This station needs one of the two instructors to be very experienced and there needs to be three instructors if an IC is instructing. Course Directors need to plan carefully in order to support instructor candidates appropriately. Instructor candidates teaching this station must be assessed by someone other than their co-instructor in the session. It helps for Course Directors to clarify the approach to the airway station during the initial faculty meeting to ensure consistency. This is particularly true of the technique for holding the mask and for ensuring that no candidate pauses with a laryngoscope in the baby’s mouth while trying to measure an oropharyngeal airway.

Key teaching objectives
To ensure that all candidates are familiar with the equipment needed to successfully control the airway and inflate the lungs of newborn babies To ensure that all candidates understand the importance of head position and jaw thrust and are able to demonstrate these tasks on a manikin All candidates must give mask inflation correctly and have a strategy to ensure chest inflation if it does not occur easily (neutral position, jaw thrust, longer inflation time, two people, oropharyngeal inspection and suction, oropharyngeal airway)

Equipment per station
Resuscitaire with functioning gas supply, pressure relief valve & T-piece circuit Two of each size, round soft silicone Laerdal type masks – size 00, 0/1 and 2 Two of each size, Guedel airways 000 (4 cm), 00 (5 cm), 0 (6 cm) Tracheal tubes with standard 15 mm connector sizes 2.5, 3.0, 3.5 – one of each Tom Thumb or similar pressure controlled T-piece Two paediatric Yankaeur suckers, or other wide bore suction catheters (12 or 14 FG) Four Laerdal style (~ 500 ml) self-inflating bags with blow off valve One Laerdal 240 ml self-inflating bag (Optional – to show it cannot achieve inflation breaths of two to three seconds) Two non-intubatable Laerdal BLS manikins (catalogue no. 14 00 10) Two intubatable Laerdal ALS manikins (catalogue no. 08 00 11) Two laryngoscopes each with one Oxford and one Wisconsin 0 blade Four towels / baby wraps, with plastic bag & hat (to show preterm thermal care) Two paediatric / neonatal stethoscopes



August 2006 (Revised September 2009)

Environment and set
The seats should be arranged around one set of equipment laid out on a low table. It is often helpful to have the algorithm visible within the station. One instructor leads the set and first two stages. Find out the backgrounds of the candidates, as this will help the instructor to make the workstation more relevant during the practical parts. Emphasise the importance of this station. All candidates must realise that if a baby needs help at birth then controlling the airway and inflating the lungs are absolutely crucial to survival. Without such control no other strategies will work. Also, control of the airway and lung inflation is usually all that most babies require.

The skill station is split into two parts; the straightforward airway techniques and the more invasive techniques. Explain to the candidates exactly what will happen. First you will demonstrate the airway techniques in real time but without explanation and they are to watch. Next you will repeat the process explaining each step. In the third stage the candidates will be asked to indicate what step to take next at each point. After this the candidates will split into two smaller groups of 3 or 4 to talk it through and practice the skills. It is entirely acceptable to use the same structure as the airway test to demonstrate the skills. 1st stage Using the (intubatable) ALS manikin, perform the following actions: Check pressure blow off is functioning (Bag) or blow off setting (Tom Thumb) before arrival of the baby Dry and wrap the baby Assess the heart rate with a stethoscope Position the baby in the neutral position (perhaps with a roll to support the shoulders) Deliver 5 inflation breaths with a correctly sized mask Assess the response by listening again with a stethoscope On finding no increase in heart rate, reposition, provide single-handed jaw thrust, check for chest movement, and call for help Listen again, still no improvement, look again – no chest movement. Your help arrives Perform two person airway control with jaw thrust resulting in a heart rate response and good chest movement Repeat stage 1, explaining each move as you perform it. Take care to demonstrate sizing of mask, correct holding and application of mask (“C” and “E” grip, avoiding distortion of the pliable edges of the mask), counting out timing of inflations, and the mechanics of jaw thrust. Emphasise the benefit of a Tom Thumb versus bag and mask, provided you have a pressurised gas supply. Repeat stage 1 asking candidates to indicate what step to perform next.

2nd stage

3rd stage

Explain that these techniques will work for most babies. However, they need to be done properly and the candidates will need a strategy to guide them if they are not immediately
NLS PROVIDER COURSE - AIRWAY STATION PAGE 2 OF 4 August 2006 (Revised September 2009)

successful. With appropriate questions and discussion draw from the candidates the list of common errors in applying these techniques and the possible further steps that might be taken if they are not successful. These steps should be written up on a board or chart – they are as listed in the table at the end of the airway chapter in the NLS manual – i.e. check neutral position, try jaw thrust, ensure a long inflation time, try two person airway control, think of possible oropharyngeal obstruction therefore inspection and suction, try a Guedel airway ……and finally intubation.

Split the candidates into two groups
4th stage In two groups: With each group the instructor first uses the non-intubatable BLS manikin (because this is the only manikin which will not inflate the chest unless correctly positioned) to demonstrate and get the candidates to practise appropriate positioning of the baby. Using this manikin, ensure: correct choice of mask correct holding of mask and supporting of jaw (“C” and “E” grip) correct positioning of head When each candidate has achieved this, move on to the intubatable ALS manikin and, ideally using a similar modified 4 stage approach, show and allow practice of: two-person airway control with jaw thrust – remove face from manikin to demonstrate jaw thrust initially – consider grip shown below use of laryngoscope sizing and placing of oropharyngeal airway

Bring the group back together. Ask for any questions. Make sure that the candidates realise the skills they have just learnt and practised. Point out that the strategy list assembled after stage 3 (neutral position, jaw thrust, two people etc) is all that is needed for the airway test.

Move the group on to the next session.



August 2006 (Revised September 2009)

A useful strategy for teaching hand positioning for jaw thrust with the ALS manikin

Control head position by holding the sides of the head with the heel of both hands, leaving the digits free.

Then place the thumbs on the maxillary prominences and the middle or ring finger of each hand on the angle of the jaw. Push down with the thumbs while pulling up with the middle or ring fingers, thrusting the jaw forward – make sure you maintain the position of the head with the palms while doing so.

When in position, lift the thumbs and ask an assistant to put the mask in place, then place the thumbs onto the mask and re-establish jaw thrust ……… perhaps holding the mask in position with the index fingers as well.



August 2006 (Revised September 2009)

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