Transcript Combitubus in Deutsch, Teil 1

Esophageal - tracheal
COMBITUBE
„Pharyngeal“
lumen No. 1
Perforations
„Esophagotracheal“
lumen No. 2
Distal
cuff
Oropharyngeal
balloon
Elbow deflector
Distal
cuff
Large (blue) syringe:
85 ml large balloon
Ringmarks
Oropharyngeal
ballon
Suction catheter
Small syringe:
10 ml distal cuff
Open
mouth,
press
away
tongue
Head:
Neutral
position
Flat
insertion
along
tongue
Elective cases:
Elective cases:
Emergency:
No. 2: 10 ml
Ringmarks
at level of
upper teeth
Emergency:
No. 1: 85 ml
(or more)
Esophageal
position
Selffixation
behind
hard palate
Ventilation
via longer
blue tube
No. 1
Active
decompression
Ventilation
via shorter
clear
tube
No. 2
Tracheal
position
Lipp maneuver
Markus Lipp
University Mainz
Frass Maneuver
Urtubia Maneuver
Combitube
Produced by:
TYCO HEALTHCARE KENDALL
Mansfield, MA
Size of COMBITUBE and
height of patient
GUIDELINES* STUDIES**
6
*TYCO
**Gaitini, Urtubia,
Panning, Krafft
5
4
3
Minimum
Maximum
2
Combitube
41 F
Combitube
37 F SA
Combitube
41 F
0
Combitube
37 F SA
1
Combitube
Specially useful:
Difficult intubation
Blind intubation
Difficult circumstances
(space, illumination)
Indications Combitube
Emergency intubation
 Bleeding and vomiting
 Immediate decompression
of esophagus and stomach

Combitube 37 SA:
ALL - IN - ONE
CONCEPT
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
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
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 facial fractures, 1 hemopneumoth
Paramedic
-Main indicationBridge
between BVM
and endotracheal tube
COMPLICATIONS
ASSOCIATED WITH THE
USE OF THE COMBITUBE
Vézina, Lessard, Bussières, et al.
Can J Anaesth 1998; 45:76-80
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
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
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
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
American Heart
Association
Guidelines for Cardiopulmonary
Resuscitation and Emergency
Cardiac Care
JAMA 1992; 268:2203
2 / 2000: Class IIa DEVICE !!!
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
European Resuscitation 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
Apnoeic patient or
unprotected airway
Anatomic alignment
(beware cervical spine)
Cricoid press ure
Ensure initial
oxygenation
Secure airway
Depending on skill
and equipment
available
*Tracheal
Intubation
Laryngeal mask
Combitube
Failure to secure airway
and adequate ventilation
Return to basic airway
technique
Unable to ventilate
Consider surgical
airway
Needle
cricothy roidotomy
Surgic al
cricothy roidotomy
VENTILATE
*Trachea intubation is best. The LMA or ETC are initial alternatives.
Conclusion
COMBITUBE
Whenever
endotracheal
intubation not immediately
possible
Short training time
Adequate ventilation
®
Combitube -
Homepage:
http://www.combitube.org
or
http://www.combitube.net

Webmaster: Roland Hofbauer