GHEMSDGApril2015 CAP Module 5 COMBITUBES COMBITUBES OBJECTIVES Review Anatomy of the Upper Airway Discuss Airway Management for the Utilizing the Combitube CAP Module 5 Combitubes ID: 634451
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Slide1
CAP Module 5 -
Combitubes (GHEMS/DG_April2015)
CAP – Module 5
COMBITUBESSlide2
COMBITUBES
OBJECTIVESReview Anatomy of the Upper Airway
Discuss Airway Management for the
Utilizing
the Combitube
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide3
UPPER AIRWAY ANATOMY
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide4
UPPER AIRWAY ANATOMY
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide5
UPPER AIRWAY ANATOMY
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide6
Airway Management
for Utilizing the
Combitube
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide7
Discussion Points
What is a Combitube
?
Indications
ContraindicationsPrecautionsEquipment
Insertion ProceduresEsophageal PlacementTracheal Placement
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide8
What is a Combitube?
A double lumen airway device designed for emergency ventilation of a patient in respiratory arrest when visualization of the airway and endotracheal intubation are not possible
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide9
What is a
Combitube?
It is designed to be inserted blindly. The double lumen design allows effective ventilations to be provided regardless of whether esophageal or tracheal placement is accomplished
Distal balloon
Pharyngeal balloon
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide10
What is a
Combitube?
The pharyngeal balloon fills the space between the tongue and soft palate, eliminating the need for a mask and the associated face mask seal problems.
The patient can be successfully ventilated regardless if the tube is inserted into the trachea or the esophagus
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide11
Indications
Primary method of airway management
for EMTs (
where allowed by local protocols
)
Respiratory failure in an unconscious patient without an intact gag reflexCardiopulmonary ArrestRespiratory Arrest
Secondary method of airway management for paramedics when
orotracheal
intubation is not possible
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide12
Contraindications
The patient has in intact gag-reflexConscious and unconscious breathing patients
The patient is less than 5 feet tall
The patient has known esophageal disease
The patient has ingested a caustic substanceKnown or suspected FBAO of larynx or trachea
The patient has an allergy or sensitivity to latex (the pharyngeal balloon contains latex)Presence of tracheostomy
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide13
Precautions
Take appropriate Body Substance Isolation (BSI) precautions including facial protection, as expulsion of stomach contents can occur through the #2 tube if the initial placement is in the esophagus.
DO NOT
force the tube. If it does not advance easily, redirect it or withdraw and reinsert
Attach the fluid deflector elbow to the esophageal tube to deflect stomach contents away from rescuers
CAP Module 5 - Combitubes (GHEMS/DG_April2015)Slide14
Equipment
Full Body Substance Isolation (BSI). Face mask, eye shield, protective eye-glasses, latex examination gloves and
hepa
-mask if patient is suspected of infectious disease
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide15
Equipment
140ml syringe
20ml syringe
Combitube
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide16
Equipment
Suction device with FR suction catheter
BVM with oxygen supply
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide17
Insertion Procedures
Place the patient in a supine position
Provide artificial ventilation via BVM and hyperventilate the patient with 100% oxygen prior to device insertion
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide18
Insertion Procedures
Inflate both balloons prior to insertion to test the integrity of the balloons
Should either balloon fail after insertion, maintenance of the patient’s airway cannot be assured
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide19
Insertion Procedures
Position the patient’s neck in a neutral position (the Combitube
is designed to be blindly inserted into the esophagus)
Lubricate the tube with sterile, water soluble lubricant
Lift the tongue and lower jaw upward to open the oropharynx
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide20
Insertion Procedures
Insert the Combitube
so that it curves in the same direction as the natural curvature of the pharynx
If resistance is met, withdraw tube and attempt to reinsert
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide21
Insertion Procedures
Advance tube until the patient’s teeth are between the two black lines
CAP Module 5 -
Combitubes
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Insertion Procedures
Inflate the #1 blue pilot cuff with 100ml of air from the large syringe
CAP Module 5 -
Combitubes
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Insertion Procedures
Inflate the #2 white pilot cuff with 15ml of air from the small syringe
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide24
Insertion Procedures
Begin ventilation through the longer blue tube labeled #1. If auscultation of breath sounds is good and gastric inflation is negative, continue
CAP Module 5 -
Combitubes
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Insertion Procedures
If auscultation of breath sounds is absent and gastric inflation is positive, then begin ventilation through the shorter clear tube labeled #2
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide26
Esophageal Placement
If the Combitube
is placed in the esophagus, the distal balloon will occlude the esophagus.
Ventilations are then provided through perforations in the side of the pharyngeal tube.
Stomach contents can then be safely expelled via the hole in the end of the tube.
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide27
Tracheal Placement
If placed in the trachea, it functions as an endotracheal tube, with the distal balloon preventing aspiration.
Ventilations are then provided via the hole in the end of the tube as in an endotracheal tube.
Stomach contents can then be safely expelled via perforations in the side of the pharyngeal tube.
CAP Module 5 -
Combitubes
(GHEMS/DG_April2015)Slide28
Insertion Procedures
During ventilation observe end-tidal CO2
monitor and/or
pulseoximetry
to confirm oxygenation
CAP Module 5 - Combitubes (GHEMS/DG_April2015)Slide29