33)Esophageal Tracheal Combitube

33)Esophageal Tracheal Combitube

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  Esophageal-Tracheal Combitube
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  Combitube An overviewWhat 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
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  Indications/Contraindications Indications LimitedC-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
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  Equipment Personal ProtectiveEquipment Gloves, Eyewear, mask Stethoscope Suction End-tidal CO2 detector Water soluble lubricant 2 syringes to inflate cuffs BVM with O2 tubing O2 Securing device
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  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
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  Tongue Jaw Lift
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  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
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  Now go securean airway…