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Combitubus in Deutsch, Teil 1

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Title: Combitubus in Deutsch, Teil 1 Author: klinpharm Last modified by: Default Created Date: 9/14/1998 5:17:46 PM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: Combitubus in Deutsch, Teil 1


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
(No Transcript)
9
Lipp maneuver Markus Lipp University Mainz
10
Frass Maneuver
11
Urtubia Maneuver
12
Combitube
  • Produced by
  • TYCO -
  • HEALTHCARE KENDALL
  • Mansfield, MA

13
Size of COMBITUBE and height of patient
GUIDELINES
STUDIES
TYCO Gaitini, Urtubia, Panning, Krafft
14
Combitube
  • Specially useful
  • Difficult intubation
  • Blind intubation
  • Difficult circumstances
  • (space, illumination)

15
Indications Combitube
  • Emergency intubation
  • Bleeding and vomiting
  • Immediate decompression
  • of esophagus and stomach

16
Combitube 37 SA
  • ALL - IN - ONE
  • CONCEPT

17
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

18
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

19
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

20
Paramedic -Main indication-
  • Bridge between BVM and endotracheal tube

21
COMPLICATIONS ASSOCIATED WITH THE USE OF THE
COMBITUBE
Vézina, Lessard, Bussières, et al. Can J Anaesth
1998 4576-80
  • 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

22
USE OF THE ESOPHAGEAL TRACHEAL COMBITUBE BY BASIC
EMERGENCY MEDICAL TECHNICIANS
Lefrançois DP, Dufour DG Resuscitation 2002
5277-83
  • 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

23
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

24
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

25
American Heart Association
  • Guidelines for Cardiopulmonary Resuscitation
    and Emergency Cardiac Care

JAMA 1992 2682203
2 / 2000 Class IIa DEVICE !!!
26
American Society of Anesthesiologists
  • Task Force on
  • Management of the
  • Difficult Airway.
  • Practice Guidelines
  • for Management of
  • the Difficult Airway.
  • Anesthesiology
  • 1993 78597-602

27
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 31201-230

28
Conclusion COMBITUBE
  • Whenever endotracheal intubation not immediately
    possible
  • Short training time
  • Adequate ventilation

29
Combitube - Homepage
  • http//www.combitube.org
  • or
  • http//www.combitube.net
  • Webmaster Roland Hofbauer
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