33)Esophageal Tracheal Combitube
Post on 14-Jan-2015
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Esophageal-Tracheal Combitube
CombitubeAn 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
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
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
CombitubeProcedure
• 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
Tongue Jaw Lift
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
Now go secure an airway…
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