0071643192.pdf

COMPLICATIONS

■ Hemorrhage if the cricothyroid artery is lacerated

■ Soft-tissue infection

A 50-year-old male is brought to ED by EMS after being found with ag-

onal respirations in a closed garage with the car running. On arrival,

the patient is being ventilated via a Combitube, but waking up and

regaining spontaneous respiratory effort. How do you want to manage his

airway now?

If you want to keep the patient intubated, an ET tube should be inserted

(with Combitube in place) after deflation of the pharyngeal balloon. If you want

to let the patient wake up, he should be rolled to the side, both cuffs deflated,

and the Combitube removed.

ESOPHAGEALTRACHEALCOMBITUBE

An esophageal tracheal combitube consists of a twin-lumen tube with a proximal

low-pressure cuff that seals the pharyngeal area, a distal cuff that seals the eso-

phagus (or the trachea), and ports for ventilation in-between (see Figure 1.2).

The pharyngeal lumen and KING LT supraglottic airways have similar

function.

It is available in two sizes only.

■ 37F: Small adult/large child

■ 41F: Larger adults

INDICATIONS

■ Apneic and unconscious adult with

■ Failed intubation

■ Limited mouth opening

CONTRAINDICATIONS

■ Patient with intact airway reflexes

■ Esophageal disease

■ Caustic ingestion

■ Upper airway obstruction

■ Children≤4 feet tall

PROCEDURE

■ Grab and elevate the tongue and jaw with nondominant hand.

■ Pass the tube blindly into the pharynx until the marker on the tube is

between the patient’s teeth.

■ Placement is facilitated by neck flexion.

RESUSCITATION

The Combitube can be used in

the setting of upper GI bleed,

but not if there is expected

esophageal pathology.