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33)Esophageal Tracheal Combitube
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33)Esophageal Tracheal Combitube



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  • 1. Esophageal-Tracheal Combitube
  • 2. Combitube An overview
    • What is it.
      • Double lumen tube inserted blindly into esophagus/trachea
    • What does it do.
      • Secures pt airway
      • EMT version of intubation
    • Anatomy…
      • Primary tube enters esophagus
      • Second tube positions in pharynx
      • Large balloon (proximal cuff) seals off pharynx
      • Small balloon (distal cuff) seals off esophagus
      • BVM attaches to pharyngeal tube and forces air into pharynx/lungs
      • Esophageal tube prevents vomiting
    • If inserted into the trachea, it can function as an endotracheal (ET) tube
  • 3.  
  • 4.  
  • 5. Indications/Contraindications
    • Indications
      • Limited C-spine injuries
      • Massive bleeding/regurgitation
      • Difficult/failed intubation
      • Lack of ALS to intubate pt
      • Respiratory arrest
    • Contraindications
      • Pt less than 5 feet tall
      • Pt younger than 14 y/o
      • Hx of caustic ingestion
      • Hx of known esophageal disease
      • Pt with active gag reflex
      • Remove it pt becomes conscious
  • 6. Equipment
    • Personal Protective Equipment
      • Gloves, Eyewear, mask
    • Stethoscope
    • Suction
    • End-tidal CO2 detector
    • Water soluble lubricant
    • 2 syringes to inflate cuffs
    • BVM with O2 tubing
    • O2
    • Securing device
  • 7. Combitube Procedure
    • Hyperventilate pt for 30 seconds with BVM
      • Rate of 10-20 breaths per minute
    • Check and prepare combitube
      • Inflate/deflate cuffs
    • Place pt head in neutral position
    • Perform a tongue jaw lift
    • Insert the combitbue midline
      • Follow curvature of the pharynx
      • Insert until teeth are between the black rings on the tube
      • Inflate the pharyngeal/proximal cuff (Blue syringe)
      • Remove syringe
      • Inflate the esophageal/distal cuff (White syringe)
      • Remove syringe
    • Attach BVM to blue tube and ventilate
    • Confirm esophageal placement
      • Observe chest rise/fall
      • Auscultate breath sounds
      • Auscultate epigastric sounds
    • No chest rise = Tracheal placement
      • Use second tube to ventilate
      • Confirm chest rise/fall
    • Bend the non used tube over and tape it to the combitube-
      • Prevents those intimately squishy moments
    • Obtain secondary confirmation with end tidal CO2 detector
    • Secure device and ventilate
  • 8. Tongue Jaw Lift
  • 9. Sellick Maneuver “Cricoid Pressure”
    • What is it.
      • Manual pressure on the cricoid cartilage
    • What does it do.
      • Prevents regurgitation/aspiration during intubation
    • Indications.
      • Unresponsive pt
      • No gag reflex
      • Intubation
    • How to do it.
      • Locate the thyroid cartilage/Adam’s apple
        • Slide your fingers to the depression just below it =Cricothyroid membrane
        • The prominence below the cricothyroid membrane is the cricoid cartilage
      • Pressure is applied to cricoid cartilage
      • This presses the esophagus against the spine
        • Gently compress with thumb and index finger
        • Apply pressure lateral of midline bilaterally
  • 10.  
  • 11.  
  • 12. Now go secure an airway…