Combitube.ppt

COMBITUBE

1. EMT Basic
Advanced Airway
Management
Pharyngeal Esophageal Airway Device
(PEAD)
A.K.A. Combitube
©
PowerPoint developed by Jennifer Stanislaw, EMT-P, EMS Training Officer
West Valley Fire District, Willamina, OR

2. The Cat Fan (No Pun Intended)

3. Agenda
Review Objectives
Lesson 1
Respiratory Anatomy & Physiology
Lesson 2
Respiratory Volume and Management
Lesson 3
Assessing Respiratory Problems

4. Agenda cont’d
Lesson 4
Respiratory/Cardiac Arrest
Basic Airway Management
Lesson 5
Suctioning
Lesson 6
Dual-Lumen Airway Devices

5. Agenda cont’d
Demonstration
Practical Stations
Basic Airway Management
Manual Maneuvers and Simple Adjuncts
Supplemental Oxygen
Ventilation
Suctioning
Combitube Insertion

6. Practical
Testing must be done with the Physician
Advisor (or another Physician of his / her
choosing)

7. Objectives
Describe the anatomy and function of the upper
and lower airways
Describe respiratory volumes and capacities in
relationship to the need for assisted ventilations
Identify the specific observations and physical
findings commonly found in patients presenting
in respiratory and/or cardiac arrest.
Identify the basic principles of airway
management

8. Objectives (cont’d)
Describe the indications for suctioning.
Identify rigid and flexible suction catheters
and the indications for use.
Identify indications and contraindications
for use of the PEAD’s.
Identify the advantages and disadvantages
of using PEAD’s.

9. Objectives (cont’d)
Identify those situations in which PEAD’s
may be removed.
Demonstrated placement of PEAD’s.
Demonstrate methods of assuring and
maintaining correct placement of PEAD’s.
Demonstrate re-ventilation for missed
placement of PEAD’s.

10. Objectives (cont’d)
Demonstrate on a manikin the proper
technique for the use and maintenance of
the following airway adjuncts:
Nasal cannula
Non-rebreather mask
Bag-Valve-Mask
Demonstrate sterile suctioning techniques
on a manikin with a PEAD in place.

11. Lesson 1
Respiratory Anatomy & Physiology

12. Respiratory Anatomy & Physiology

13. Function of the Respiratory System
Removes carbon
dioxide from the blood
Transfers oxygen to
the blood

14. The Upper Airway
Epiglottis
Mandible
Frontal Sinus
Soft Palate
Trachea
Glottis
Esophagus
Vocal Cords
A
B
C
D
E
F
G
H

15. The Upper Airway
Other Structures
Nasopharynx
Oropharynx
Hypopharynx
Larynx
Functions

16. Functions of the Upper Airway
Passageway for air
Warm
Filter
Humidify
Protection
Gag Reflex
Cough
Speech

17. The Lower Airway
Primary Bronchi
Hyoid Bone
Right Lung
Secondary Bronchi
Tracheal Ligament
Trachea
Larynx
Esophagus
Left Lung
Trachea
A
B
C
D
E
F
G
H
I
J

18. Alveoli
Gas Exchange

19. Lungs
Structure
Lobes
Pleura

20. Physiology of Respiration
Define Respiration
The exchange of gases between a living
organism and the environment
Define Ventilation
Mechanical Process that moves air in and out of
the lungs

21. Muscles of Breathing
Intercostal Muscles
Diaphragm

22. Regulation of Respiration
Where is the Respiratory Center Controlled?
Brainstem
Medulla
Apeustic Center (pons)
Pneumotaxic center (pons)
Stretch receptors
Hering-Breuer reflex
Chemoreceptors
CSF
Blood

23. Voluntary or Involuntary
Both
Humans can override body’s urge to breathe
But only for so long

24. Respiratory Cycle
Inspiration
Active phase
Lasts 1-2 seconds
Expiration
Passive phase
Lasts 5 seconds

25. Lesson 2
Respiratory Volume and
Management

26. Drinking Straw Exercise
Breathe through
straws for 1 minute

27. Carbon Dioxide & The Respiratory
System
High CO2
Increases respiratory rate
Low CO2
Decreases respiratory rate
Hypoxic Drive
Chronic COPD patients

28. Normal Respiratory Rates
Adult
Children
Infants
Newborns
12 –20 / min
18 –24 / min
22 –36 / min
40 –60 / min

29. Factors Affecting Respiratory Rate
Fever
Depressant Drugs
Anxiety
Insufficient Oxygen
Stimulant Drugs
Sleep

30. Respiratory Volumes
Lung Capacity
Tidal Volume
Dead Space
Alveolar Air
6000 mL of air
500 mL at rest
150 mL
350 mL

31. Minute Volume
Total air moved per minute
Rate X Volume = Minute volume
Important Assessment Item

32. Factors Affecting Minute Volume
Head, neck, chest injury
Shock
Diabetes
CO2 / O2 rapid changes

33. Maintaining the A in ABC
Patient positioning
Suctioning
Supplemental Oxygen
Mechanical Assistance

34. Pulse Oximetry
Measures amount of oxygen in the blood.
Gives percent of hemoglobin saturated
Tool only, do not rely on totally
Why?
Normal Values
95% -100% Normal
90% -95% -Mild –Normal for COPD
< 90 % Moderate –High Flow Oxygen

35. End-Tidal CO2 Detection
Measured
Colorimetric and Digital
Tool to aid in determining correct placement

36. Lesson 3
Assessing Respiratory Problems

37. Patient Assessment

38. General Patient Assessment
Primary Survey
LOC
ABC’s
Speech Pattern
Obvious Respiratory Noise
Patient Position

39. General Assessment (cont’d)

40. Secondary Assessment
SAMPLE history
Chief Complaint
Pertinent Negatives
Chest Pain (pleuritic vs cardiac)
Cough History
Edema
Vitals

41. Respiratory Assessment
Confusion, Agitation, Orientation
Cyanosis (late sign)
Diaphoresis
Retractions
Accessory Muscle Use
Jugular Venous Distention
Nasal Flaring / Pursed Lip Breathing

42. Palpation
Skin
Turgor
Color
Temperature
Diaphoresis
Pulse
Rate
Rhythm
Quality
Chest Wall Pain
Tracheal Deviation

43. Assessing Lung Sounds
Methods
Hand Out

44. Lung Sounds
Normal
Wheezes
Rales (Crackles)
Stridor
Rhonchi
Pleural Rub
Listen on every patient
End of Expiration
End of Inspiration
During both phases
Expiration
End of Inspiration

45. Respiratory Diseases
COPD
Asthma
Pneumonia
Pulmonary Edema
Pulmonary Embolus
Trauma

46. COPD

47. Chronic Obstructive Pulmonary
Disease
Pink Puffers and Blue Bloaters
Frequently on Home oxygen
Assessment
Typical Lung Sounds
Common Medications
May or May not be Hypoxic Drive

48. Asthma

49. Asthma
Bronchiole Constriction & Mucous
Production
Lung Sounds
Wheezes
Diminished
None
Usually Diagnosed

50. Pneumonia

51. Pneumonia
Fever
Productive Cough
Colored Sputum
General Illness
Elderly & Pediatric most at risk
Lung Sounds
Rhonchi, Rales, Wheezes

52. Pulmonary Edema

53. Pulmonary Edema
Congestive Heart Failure
Acute –Flash Pulmonary Edema
Chronic –Heart Failure
Medications
Orthopnea, PND
Lung Sounds
Keep them upright with legs dangling

54. Pulmonary Embolus

55. Pulmonary Embolus
Lung Sounds
History
Surgery
Bed Confined
Long trip
Rapid Transport & High Flow Oxygen

56. Trauma

57. Trauma
Maintain spinal control
Airway Management
High Flow Oxygen
Rapid Transport
Seal Chest Wounds
Stabilize Impaled Objects

58. Lesson 4
Respiratory/Cardiac Arrest
Basic Airway Management

59. Respiratory & Cardiac Arrest

60. Assessing the Patient
First Steps of CPR
Annie, Annie You Okay?
Other Signs and Symptoms
Unconsciousness
Cardiac Seizure
Agonal respirations or apnea
Cyanosis, Ashen, Mottled
No signs of spontaneous respiration or circulation
No Pulse

61. Combitube

62. When to Use the Combitube
CPR
Remember to do CPR!
Attach AED!
Respiratory Arrest
Agonal Respirations without intact gag reflex
Respiratory Arrest leads to Cardiac Arrest

63. Airway Management –The Basics
Manual Maneuvers
Chin Lift
Jaw Lift
Jaw Thrust
Head Tilt –Chin Lift
Modified Jaw thrust

64. Airway Management –The Basics
Mechanical Airways
NPA’s
OPA’s
Description
Advantages
Disadvantages
Indications
Contraindications
Methods of Insertion

65. Airway Management –The Basics
Ventilation
Mouth to Mask
BVM
Description
Advantages
Disadvantages
Indications
Contraindications
Methods of Use

66. Evaluation of Effectiveness
How do I know I am ventilating?
Chest movement
Lung Sounds
Epigastric sounds/Abdominal distention
Patient Response

67. Lesson 5
Suctioning

68. Reviewing Suctioning
BSI –Scene Safety
Equipment
Suction device
Rigid or Soft Tip
Insert with Suction Off
Withdraw while
Suctioning
No more than 15
seconds before
ventilating!

69. Oh, That Sucks!
Vomitus
Food
Protein dissolving
enzymes
Hydrochloric Acid
Aspiration damage
Alveolar Damage
Increased fluid
Obstruction
Aspiration Pneumonia

70. Oh, Go Spit on It
Saliva
Digestive enzymes
Bacteria
Aspiration Damage
Fills alveoli
Pneumonia

71. Food
Clogs airways
Interferes with
ventilation
Pneumonia

72. Blood
Contents
Protein
Fibrin
Water
Electrolytes
Aspiration Damage
Clog small airways
Creates chemical
reaction

73. Suction Catheters
Rigid
Advantages
Disadvantages
Indications
Contraindications
Methods of Use
Flexible
Advantages
Disadvantages
Indications
Contraindications
Methods of Use

74. Lesson 6
Dual-Lumen Airway Devices

75. Combitube
©

76. Description
Other Similar Devices
Pharyngeal tracheal lumen airway (PTLA)
EGTA
EOA
What we use
Combitube
©

77. Indications for Combitube
©
Respiratory Arrest
Cardiac Arrest
Unconscious, without a gag reflex

78. Contraindications for Combitube
©
Gag Reflex
Conscious
Breathing Adequately
Caustic Ingestion
Known esophageal disease or varices
Under 16 y/o
Under 5 feet or over 6 feet 8inches

79. Advantages for Combitube
©
Rapid Insertion
Limits regurgitation, aspiration & distention
Blind insertion
High oxygen delivery
Less training required
Inserted in neutral position

80. Disadvantages for Combitube
©
Patient must be unresponsive without gag
reflex
Some are difficult to obtain adequate seal
Some do not totally protect against
aspiration
Most responsive patients will vomit when
removed
May damage esophagus

81. Demonstration

82. When Can I Remove the Combitube?
Patient returns to full consciousness
Patient able to maintain own airway
Orders from OLMC

83. Procedure for Removing
SUCTION READY!
Deflate Tube #2
Deflate Tube #1
Tell patient to exhale
Pull out quickly and in-line
SUCTION

84. Demonstration

85. Skills Labs
Basic Airway Management
Manual Maneuvers and Simple Adjuncts
Supplemental Oxygen
Ventilation
Suctioning
Advanced Airway Management
Combitube

86. Questions?