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„Pharyngeal“ lumen No. 1

Esophageal - tracheal COMBITUBE. „Pharyngeal“ lumen No. 1. Perforations. Distal cuff. „Esophago- tracheal“ lumen No. 2. Oropharyngeal balloon. Large (blue) syringe: 85 ml large balloon. Elbow deflector. Distal cuff. Ringmarks. Oropha- ryngeal ballon. Small syringe:

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„Pharyngeal“ lumen No. 1

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  1. Esophageal - tracheal COMBITUBE „Pharyngeal“ lumen No. 1 Perforations Distal cuff „Esophago- tracheal“ lumen No. 2 Oropharyngeal balloon

  2. Large (blue) syringe: 85 ml large balloon Elbow deflector Distal cuff Ringmarks Oropha- ryngeal ballon Small syringe: 10 ml distal cuff Suction catheter

  3. Open mouth, press away tongue Head: Neutral position

  4. Flat insertion along tongue

  5. Elective cases: Elective cases: Emergency: No. 2: 10 ml Emergency: No. 1: 85 ml (or more) Ringmarks at level of upper teeth

  6. Ventilation via longer blue tube No. 1 Esophageal position Self- fixation behind hard palate Active decom- pression

  7. Tracheal position Ventilation via shorter clear tube No. 2

  8. Lipp maneuver Markus Lipp University Mainz

  9. Frass Maneuver

  10. Urtubia Maneuver

  11. Combitube Produced by: TYCO - HEALTHCARE KENDALL Mansfield, MA

  12. Size of COMBITUBE and height of patient GUIDELINES* STUDIES** *TYCO **Gaitini, Urtubia, Panning, Krafft

  13. Combitube Specially useful: • Difficult intubation • Blind intubation • Difficult circumstances (space, illumination)

  14. Indications Combitube • Emergency intubation • Bleeding and vomiting • Immediate decompression of esophagus and stomach

  15. Combitube 37 SA: ALL - IN - ONE CONCEPT

  16. Conclusions the 37 Fr Combitube SA is... • the “standard“ Combitube • safe and efficient • insertion under direct vision recommended • slow inflation of oropharyngeal balloon • inflation volume: height (cm) - 100 or weight (kg) - 5 • suitable for all patients in whom tracheal • intubation has to be avoided

  17. FAILED RAPID SEQUENCE INTUBATION IN TRAUMA PTS. Blostein, Koestner, Hoak J Trauma 1998; 44: 534-537 • Use of ETC in trauma pts. in whom orotracheal rapid sequence intubation failed • Flight nurses trained with ETC • 12 pts. had ETC, 10 included

  18. FAILED RAPID SEQUENCE INTUBATION IN TRAUMA PTS. • Successful in all patients • Definitive airway control in ED: orotracheal (7), tracheostomy (2), cricothyroidotomy (1) • 7 mandible fractures, 4 TBI, 2 fa-cial fractures, 1 hemopneumoth

  19. Paramedic -Main indication- • Bridge between BVM and endotracheal tube

  20. COMPLICATIONS ASSOCIATED WITH THE USE OF THE COMBITUBE • 1139 pts. CPR with ETC + SAED • 2 pts. transparietal lacerations of anterior wall of esophagus • Distal cuff inflated with 20 to 40 ml !!! Maximum 12 ! CPR; CPPV Vézina, Lessard, Bussières, et al. Can J Anaesth 1998; 45:76-80

  21. USE OF THE ESOPHAGEAL TRACHEAL COMBITUBE BY BASIC EMERGENCY MEDICAL TECHNICIANS Lefrançois DP, Dufour DG Resuscitation 2002; 52:77-83 • 420 Emergency medical technicians + automatic external defibrillator (EMT-Ds) • Firefighters with BLS-D • 125-350 h course curriculum for EMTs • 18 h training with AED and Combitube • Assessment of location with EDD (syringe) + auscultation

  22. USE OF THE ESOPHAGEAL TRACHEAL COMBITUBE BY BASIC EMERGENCY MEDICAL TECHNICIANS • Montérégie / Quebec: 11,000 square km, population of 1.3 million • Successful placement in 725 out of 760 cardiac arrest patients (95.4 %) • Ventilation successful in 695 (91.4 %) pts. • Autopsy in 133 pts.: no esophageal lesions or injury to airway structures • EMT-Ds can use ETC safely + effectively

  23. Merits of COMBITUBE • Low price, all-in-one device • Non invasive • No preparations necessary • Rapid and easy intubation • Immediate fixation • PREVENTION OF ASPIRATION • HIGH VENTILATORY PRESSURES • No power supply

  24. American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiac Care JAMA 1992; 268:2203 2 / 2000: Class IIa DEVICE !!!

  25. American Society of Anesthesiologists Task Force on Management of the Difficult Airway. Practice Guidelines for Management of the Difficult Airway. Anesthesiology 1993; 78:597-602

  26. European Resus-citation Council Baskett PJF, Bossaert L, Carli P, Chamberlain D, Dick W, Nolan JP, Parr MJA, Scheidegger D, Zideman D: Guidelines for the advanced management of the airway and ventilation during resuscitation. Resuscitation 1996; 31:201-230

  27. ConclusionCOMBITUBE • Whenever endotracheal intubation not immediately possible • Short training time • Adequate ventilation

  28. Combitube® - Homepage: • http://www.combitube.org or • http://www.combitube.net Webmaster: Roland Hofbauer

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