33)Esophageal Tracheal Combitube

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33)Esophageal Tracheal Combitube

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

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