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…