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Difference between airways


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17 replies to this topic

#1 MikeEMT

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Posted 10 December 2012 - 06:40 AM

So can someone explain to me the differences between the blind insertion airways (i.e. combitube, King) and an actual endotracheal tube?

As a basic we can do the combitube but obviously can't intubate. I have heard that combitubes are not to be used for long term airway support.

Looking at them they look pretty much identical to me (other than the fact that combitubes are dual lumen).

I know there has to be some differences in functionality otherwise intubation would be a basic skill. So what exactly makes an ET tube different from a combitube?

Elementary question, but one that I have been curious about.
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#2 Curiosity

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Posted 10 December 2012 - 01:11 PM

We don't use combitubes here anymore. We have kings now. One difference is, blind insertion vs visualized insertion.

Blind slips in without the need to see the anatomy and sits on top of the vocal cords. It directs the air flow towards the trachea, reducing gastric insuflation. They don't however provide a definitive airway. There's a risk of aspiration if the patient vomits because the vomiting may not be visible because of the tube blocks the view.

Intubation requires the anatomy to be seen and a tube passed through the vocal cords. There's more to it than just push a tube in. Landmarks, techniques, troubleshooting difficult airways. This tube completely isolates the trachea therefor in case of vomiting, the risk of aspiration is minimal.

They both have pros and cons, kings are faster and much simpler to insert but don't offer the long term protection of intubation. I find monitoring with a et tube easier than a king lt. Greater risk of damaging the anatomy with an et tube (improper techniques). Et tubes also require a lot of practice and is a skill one needs to maintain in order to be proficient.
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#3 Resqmedic

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Posted 10 December 2012 - 02:43 PM

Intubation is still the gold standard for securing an airway, blind insertion airways have been gaining popularity, and every year I hear that paramedics will no longer perform ETs, But I still see all the air medical services(around here anyway) using only ET tubes, as well as in the ER's. Feel free to correct me if I am wrong, and I would like to know of services that no longer use ETs as well!
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#4 island emt

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Posted 10 December 2012 - 02:55 PM

As said above the endotracheal tube is the gold standard for secure a definitive airway. After inserting an inflatable ballon cuff is filled which occludes the area around the tube making aspiration all but impossible. the combitube or king or any of the other blind insertion airways are just a set of tubes that are introduced into the oropharynx in the hope that one will hit the trachea and one the esophagus. The LMA is along the same lines, it looks like a part of the female anatomy that is placed in the anterior throat in an attempt to control airway. It won't stop aspiration or stay put when bouncing down the road.
Plus the multi tube adjuncts are way more expensive to purchase and have the same short expiration dates as ET tubes, which cost about $3.35 ea instead of $50.00 like the combitubes , or $38.00 for the king.
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#5 paramedicmike

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Posted 10 December 2012 - 04:07 PM

I know there has to be some differences in functionality otherwise intubation would be a basic skill. So what exactly makes an ET tube different from a combitube?


I don't have a lot of time to get into detail here. But don't fool yourself thinking that it is simply functionality separating a skill between paramedics and EMTs.

I'll expand later when I have a little more time.
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