1 / 29

„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:

nijole
Télécharger la présentation

„Pharyngeal“ lumen No. 1

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related