Mask Ventilation & the LMA

Before any airway, lay out SALT: Suction (the most-forgotten piece), Airway (oral airway), Laryngoscope, Tube (ETT). For an emergency airway, get a quick history — W²A²S²: Why/what airway, Weight, Age, Allergies, Significant history, Stomach (last meal).

The four basic airway skills to build on a rotation: 1. Mask ventilation 2. LMA placement 3. Intubation 4. Confirming the LMA/ETT is correctly placed and working.

Anatomy from the top down: nasopharynx → oropharynx → hypopharynx → larynx → trachea (to the carina).

This is the skill to obsess over — being able to mask buys you and the patient time.

• Pick the right-size mask; use a chin lift / jaw thrust.
• Think of bringing the jaw up to the mask, not pushing the mask down onto the face.
• Give just enough positive pressure for a good chest rise — and keep airway pressure below ~20 cmH₂O. Higher pressures open the esophageal sphincter and inflate the stomach → harder ventilation and regurgitation risk.
• Confirm: chest rise, breath sounds, EtCO₂.

Adjuncts: - Oral airway (OPA) — sized corner of mouth to angle of jaw; will trigger gagging/vomiting if the gag reflex is intact, so avoid placing in a light/stage-2 patient (laryngospasm). - Nasal airway (NPA, "trumpet") — sized naris to angle of jaw; doesn't trigger the gag reflex but can cause epistaxis — pre-treat the nose with a vasoconstrictor and lubricate.

A laryngeal mask is a "mask" that sits in the hypopharynx over the larynx. It's placed blind and is an excellent rescue device.

Placement: size by weight (printed on the package), lubricate, head neutral, advance against the hard palate until gentle resistance — it seats over the airway. Inflate (it often backs out slightly as it seats), connect the circuit, confirm with one gentle breath (chest rise, breath sounds, EtCO₂), and tape.

The LMA is not a secured airway — if the patient regurgitates, contents can pool in the bowl and be directed toward the trachea. It doesn't protect against aspiration.