LMA

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Unfortunately, Keith, the LMA already has conquered the globe. I get the
impression the USA is very much behind the times in this regard!

I would not contemplate not having an LMA available any time I am
intubating a patient (in trauma or ICU). The intubating LMA (ILMA) is
considered by very many people to be the emergency airway of choice in a
failed intubation scenario in trauma or in the ICU. LMAs are carried in
ambulances, and are now mandatory equipment for nurses in isolated rural
hospitals without immediate medical backup.

We keep both classic LMAs and disposable ILMAs in all sizes in each ICU
intubation trolley. The disposable ILMAs are cost effective as we don't
intend using them very often (from memory about AU$50, compared to about
AU$900 for the reusable device). 

I used an ILMA in anger about a week ago. A 72 year old woman, chest
injury with flail sternum, multiple rib fractures and an unstable
odontoid fracture now had partial airway obstruction after some
morphine. We tried a textbook trauma rapid sequence induction with
inline stabilisation, could only just see the tip of the epiglottis down
a deep dark hole and could not blindly pass a bougie behind the
epiglottis. One (immediately recognised) oesophageal intubation.
Solution - insert ILMA, ventilate for a bit then intubate through it.
Worked like magic. Later on, surgical fixation of neck and tracheostomy,
and she is doing just fine.

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Staff Specialist in Intensive Care Medicine
The Nepean Hospital, 
PO Box 63, Penrith NSW 2751
Clinical Lecturer, University of Sydney


>>> KLamb at Christianacare.org 5/04/2006 1:47am >>>
I've never seen an LMA used outside of our OR's. We are a very busy
trauma
center, and I've not seen one used in our ED, or by our pre-hospital
personnel. We do however keep one in each of our code boxes, to be used
as a
difficult airway adjunct. Hardly seem poised to conquer the globe, at
least
in this area.

Keith


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