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Advanced Airway Management

Advanced Airway Management. COMBITUBE. Adjunctive Airways. Endotracheal Intubation – ET Esophageal Obturator airway – EOA Esophageal gastric tube airway – EGTA. Complications With EOAEGTA. Esophageal rupture Gastric rupture Endotracheal intubation Bag-valve-mask ventilation. Combitube.

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Advanced Airway Management

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  1. Advanced Airway Management COMBITUBE

  2. Adjunctive Airways • Endotracheal Intubation – ET • Esophageal Obturator airway – EOA • Esophageal gastric tube airway – EGTA

  3. Complications With EOA\EGTA • Esophageal rupture • Gastric rupture • Endotracheal intubation • Bag-valve-mask ventilation

  4. Combitube • Ventilation in either esophageal or endotracheal position • Blind placement • No patient neck movement

  5. Combitube - Design • Lumen #1 - esophageal obturator lumen • Lumen #2 - tracheal lumen • Pharyngeal balloon • Esophageal cuff – distal balloon

  6. Combitube

  7. Indications • Endotracheal intubation cannot be done • Endotracheal intubation unsuccessful • Limited patient access • High risk for c-spine injury

  8. Contraindications • Less than 16 years old • Less than five (5) feet tall • Intact gag reflex • Known esophageal disease • Caustic ingestion

  9. Procedure • Start CPR, oxygen and defibrillation • Check Combitube balloons for leaks • Lift lower jaw and tongue • Insert Combitube following curve of the pharynx • Stop when black rings line up with upper teeth or alveolar ridge

  10. Procedure – Cont. • Inflate blue pilot balloon with 100 cc of air • Inflate white pilot balloon with 10-15 cc of air • Ventilate using longer blue tube – No. #1 • Listen for breath sounds, if none … • Switch to the shorter clear tube – No. #2 • Recheck breath sounds

  11. Other Information • Oxygen saturations similar • Caution when giving drugs • Skills maintenance requirements

  12. Summary • Rapid, effective airway management • Ease of insertion • Airway is self-anchored • Posterior balloon protects from oral secretions • Posterior balloon can be deflated for visualization during endotracheal intubation

  13. Summary –Cont. • Posterior balloon protects from oral secretions • Posterior balloon can be deflated for visualization during endotracheal intubation • Gastric contents can be suctioned

  14. Combitube

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