Self Intubation

[akroeze]

Out of curiosity, how many of you insert a gastric tube when you intubate? Just curious.

[Jess]

One of the things I've always wondered about the ComboTubes, and devices like them, but have never heard addressed...though it nearly was in the first video....

With the cuff inflated in the esophagus, it seems that there are a lot of opportunities for damage if it's vomited against strongly. That seems like a silly risk with dire, long lasting consequences if it goes wrong.

Once again, this is one of those questions that seem pretty obvious, so as I've not heard it mentioned in the many 'rescue airway' threads, I'm guessing there's something pretty simple that I'm missing.

This is what I see...The cuff is inflated, a full belly attempts to eject it's contents and the tube is forced out of the esophagus and airway control fails. Or the cuff holds, causing distention, and possible tearing, leading to a whole ream of possible issues.

I've sometimes thought, "Well, perhaps you don't vomit so violently when obtunded or unresponsive?" But then of course there are the gazillions of stories of crews cleaning the roof of the ambulance after some coronary/head trauma runs....

So is there some physiological safe guard that I'm failing to see that takes over when unstoppable emeses meets immovable airway device?

Dwayne

Dwayne you brought up an excellent point! While there is a valve on the combitube that I lovingly call the "Puke valve" I understand what your saying about the pressure of the vomit meeting the airway device and how it can cause damage. So I researched it because I'm just as curious as you are. This might provide some insight. It might answer your question or it may not but I took a shot at this. Its a study some doctors did to compare seals in supraglottic airway devices.

A Comparison of Seal in Seven Supraglottic Airway Devices Using a Cadaver Model of Elevated Esophageal Pressure

Sven Bercker, MD*, Willi Schmidbauer, MD{dagger}, Thomas Volk, MD{ddagger}, Gottfried Bogusch, PhD§, Hans Peter Bubser, MD{dagger}, Mario Hensel, MD{ddagger}, and Thoralf Kerner, MD{ddagger}

From the *Department of Anesthesiology and Intensive Care Medicine, Leipzig University Hospital, Germany; {dagger}Department of Anesthesiology and Intensive Care Medicine, Bundeswehrkrankenhaus, Berlin, Germany; {ddagger}Department of Anesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, and §Center for Anatomy, Charité-Universitaetsmedizin, Berlin, Germany.

Address correspondence and reprint requests to Dr. Sven Bercker, Klinik für Anästhesiologie und Intensivtherapie Universitätsklinikum Leipzig, Liebigstr.20, 04103 Leipzig Germany. Address e-mail to sven.bercker@medizin.uni-leipzig.de.

Abstract

BACKGROUND: Supraglottic airway devices are increasingly important in clinical anesthesia and prehospital emergency medicine, but there are only few data to assess the risk for aspiration. We designed this study to compare the seal of seven supraglottic airway devices in a cadaver model of elevated esophageal pressure.

METHODS: The classic laryngeal mask airway, laryngeal mask airway ProSealTM, intubating laryngeal mask airway FastrachTM, laryngeal tubeTM, laryngeal tube LTS IITM, CombitubeTM, and EasytubeTM were inserted into unfixed human cadavers with an exposed esophagus that had been connected to a water column of 130 cm height. Slow and fast increases of esophageal pressure were performed and the water pressure at which leakage appeared was registered.

RESULTS: The Combitube, Easytube, and intubating laryngeal mask Fastrach withstood the water pressure up to more than 120 cm H2O. The laryngeal mask airway ProSeal, laryngeal tube, and laryngeal tube LTS II were able to block the esophagus until 72–82 cm H2O. The classic laryngeal mask airway showed leakage at 48 cm H2O, but only minor leakage was found in the trachea. Devices with an additional esophageal drain tube drained fluid sufficiently without pulmonary aspiration.

CONCLUSIONS: Concerning the risk of aspiration, the use of devices with an additional esophageal drainage lumen might be superior for use in patients with an increased risk of aspiration. The Combitube, Easytube, and intubating laryngeal mask Fastrach showed the best capacity to withstand an increase of esophageal pressure.

http://www.anesthesia-analgesia.org/cgi/co...tract/106/2/445

[mobey]

This is a plus for the King airway. There os a large opening into the esophagus for drainage and tubes. *As far as non-visualized airways are concerned*

[Dustdevil]

Unfortunately, the ability to withstand elevated oesophageal pressures is only one facet to be considered. We need to know why those devices excel at doing so. Are they achieving this seal at the cost of significantly increased cuff pressures, and the consequential risk of mucosal or oesophageal damage?

[Jess]

I'm still doing some more in depth research, Dust. I will post my findings here, if there are any findings.

[Dustdevil]

I'm still doing some more in depth research, Dust. I will post my findings here, if there are any findings.

Plus 5! I didn't mean to be critical of your post. It's awesome that you found that!

[Jess]

Plus 5! I didn't mean to be critical of your post. It's awesome that you found that!

Oh No I didn't take it that way at all! I just wanted to post what info I did have because this could take me many hours to find the rest of the info that I'm looking for. I have nothing better to do today since I'm sitting here with gobs of lotion on my feet, feet wrapped in saran wrap with socks on!! lol! Mind you, it works absolutely FANTASTIC if you are prone to over dried out cracked feet Okay back to my research!