Episode 20 - The Supraglottics

Episode 20 - The Supraglottics


April 2024


Dr. John Hill

Scott Wildenheim

Caleb Ferroni

Ray Pace

Episode Video

Part 6 - Supraglottic Introduction

Part 7- Capnography and Tube Holders

Part 8 - King Airway

Part 9 - i-Gel 

Part 10 - Laryngeal Mask Airways

Episode Audio

Show Notes

Supraglottic airways remember (Supra) meaning above the airway, or extra glottis opening

The State of Ohio Procedures include Basic EMTs can use supraglottic airways with the pulseless and apneic patients. In addition, Advanced EMTs can perform the procedure on an apneic patient.

No longer should we be under an impression that they are not a “Gold standard” airway.

Outcomes are just as successful as direct visualization Intubations (ET) for the short-term use patients.

Remember, Anesthesia “The gold standard in airways” are using these exclusively for short-term patients in the surgical settings.

In terms of preparation, BIADs (Blind insertion airway device) should be in the plan for a failed airway should we be unable to get a secured airway by any other means.

Always prepare to fail in airway so that the next step is ready and quickly obtainable.

Some steps to preparing to fail an airway should include:

1. Video assistance

2. Direct

3. Supraglottic

4. Surgical

Do not forget, your first attempt is your best attempt.

Data that has shown one BIAD is not any better than another. They all do great jobs. University Hospitals have decided to use Igel in protocol. However, the EMS protocol with UHEMSI has not changed in that we can still use one over another.

Remember that we have options, and the most important thing to remember is to know your equipment and how to use it!

Remember, not only does capnography fit every airway we use, it is also mandatory per protocol that waveform capnography be used.

Do not forget to calibrate that capnography. Screw the sampler line into the monitor and wait for the machine to calibrate prior to placing it on the patient so that you get correct reading.

Reading waveform capnography can be extremely beneficial. Do not forget also, this is a Basic EMT skill. Knowing your equipment is also so important.

There are many types of tube holders on the market. The Thomas tube holder is the most used. Do not forget, they come in three sizes. Dark blue, lighter blue and very light blue. The very light blue ones will only hold an ET tube. You will not be able to fit a BIAD. Thomas tube holders also make a tube holder with a channel that will fit these BIADS, like the Igels.

The newer Igels are coming as kits, these include securing devices.

Remember that all supraglottic are contraindicated for any patient exposed to caustic agents.

Unlike the ET tube, you cannot put any medications down the BIAD. This has been more by the wayside in ET tubes as well since the introduction of I.O. use.

Breaking down the different BIADS

King airways

Some pediatric sizes. They are height based. Adult 3, 4, 5. Ray likes to size in reverse.

If they are greater than 6 foot, use a size 5 Large Adult.

If they are in the 5 to 6 foot range, use a size 4. Adult.

In addition, if they are 4 to 5 foot, rage you use a size 3. Small adult.

The amount of air needed for inflation is all listed on the side of the tube. It will mostly range from 60-80cc.

Once you connect BVM and you are not having good chest rise and fall, it is most likely a seating problem. It needs to be withdrawn slightly. However, if you pull it back too far, it can completely occlude the airway.

Also, they are made of nitrile. So anytime you nick a tooth, it will lacerate the cuff.

If you have gastric contents in the tube, this does not mean misplaced. It is dual channeled.


They are weight based. Offer a comfortable margin both ways in sizing that overlap the tube above or below your estimate. All indicated on the tube itself. They also have pediatric size.

Much like the King Airway, they are sized,

5 Large Adult.

4. Adult.

3. Small adult.

The newer versions have a couple of extras. They will have pegs on the top that are used with the provided neck strap for securing the device. They also have an oxygen augmentation port. This is primarily used in the surgical setting. We will most likely not be using this port, but when is extremely important is that this is capped off (Shut).

There is no cuff to inflate. This makes them very quick to place.

Do not forget, when placed correctly, the bite block will be positioned over the teeth. They have a suction port built in.

LMA (Laryngeal Mask Airway)

Sometimes called the grandparent of the Igel, is the LMA.

These work basically the same way as Igel. However, do have a cuff that will be inflated after insertion.

They also have pediatric sizes.

Remember, with BIADs, they will ultimately be replaced with an ET tube. This will most likely be done in the “controlled” Emergency Department setting.

With any of the options for airways, never let the first time you use them be on a patient! Practice makes perfect.

The Protocols

From The Episode

Caleb listens to Dr. Hill describe airway badness

Ray demonstrates a King airway

Dr Hill discusses changing a supraglottic to an ET tube

Scott practices airway karate