Back up Airway Devices; the Good, the bad, and the Ugly.

[NREMT-Basic]

Perhaps it is my minimal experience so far with combis, but i was not aware that you could also place an ett with a combi in place. Would a medic with alot of experience in this area please post and enlighten me as to how this is done so that i may increase my knowledge base....i was taught that it was one or the other and it would be good to have other information at my fingertips.

[AZCEP]

It is possible, but it can be a bit crowded.

Fully deflate the proximal cuff of the ETC, so that it is fully flattened against the tube. Leave the distal cuff inflated, unless you really want to know what the patient had for lunch.

Sweep the tube to the left corner of the mouth with the laryngoscope, and visualize the vocal cords normally. Pass the ETT, and secure in place. Leave the ETC in place, and place an OG tube through it. Once the OG is in place, you can remove the ETC, but you really shouldn't want to. When you do this the patient will puke, no variation at all. It always happens.

[NREMT-Basic]

Ace-

The information you provide is great, but for the love of god would you just link the articles and not reprint the whole thing so that we can read it if we want to and not have to texas two step around it to get to others if we dont.

[chbare]

AZCEP, I wonder if using a bougie would be helpful for intubation around a combitube?

Take care,

chbare.

[Spock]

I probably wouldn't bother with a bougie. I would put a salem sump down the esophageal lumen and decompress the stomach first; you just have to use a small one (12Fr) which won't remove any chunks just fluid. The manufacturer has a protocol for removing the combitube. I have intubated around the combitube and also removed it before intubating in the standard fashion. It is probably safer to leave the esophageal balloon inflated and intubate around the combitube as AZCEP described.

The sales rep brought in the new King airway yesterday and it looks promising. You can place a 6.0 through the LT-D but not through the new model with the esophageal suction port. You can use a bougie with both. We are supposed to get some samples of the new model soon and I will let you know how the work. We are not paying any where near $35--the LT-D is $14 and the new model is only a few dollars more. They may be giving us a good price in order to build the market.

Live long and prosper.

Spock

[Spock]

Hey how about that--my 100th post and I am now a freshman! That makes me feel young again. To bad I'm at work or I'd go out and get drunk and stupid!

Live long and prosper.

Spock

[AZCEP]

The way the sales rep described it to me, was the LT-D by itself is $15. The EMS set with the LT-D, the syringe, KY, and Instructions(?) are $55.

I have not considered using a bougie with the ETC in place, but I've only needed to intubate around it 3-4 times. In theory if you are thinking tough airway, it might be reasonable. Let me repeat, DO NOT remove the ETC when intubating. You will only end up with a vomit filled airway, and you won't be able to see anything.

[n3qtrtme]

The sales rep brought in the new King airway yesterday and it looks promising. You can place a 6.0 through the LT-D but not through the new model with the esophageal suction port. You can use a bougie with both. We are supposed to get some samples of the new model soon and I will let you know how the work.

Spock, You CAN place a 6.0 through the new LTS-D... I have done it. Just wet or lube your tube and push it in. When you get your samples, try it out. Trust me, it'll work.

[AZCEP]

Why would you want to use a tube that small?

Place the bougie, pull the LT, slide a size appropriate ET over it. No benefit in having an ETT that is too small for the airway you are trying to secure.

[Spock]

I've had to do some work on the cost of the King LT-D since our command system just approved it. The EMS kit is $375 for ten which is $37.50 each. If you buy all three sizes the cost is more than one combitube which is a significant negative in my mind no matter how much I like the King. Hospitals can buy the airway only for $12-14. There is nothing to prevent a command hospital from buying the airways and selling them to EMS at cost. Our command hospital is doing just that. The sales rep gave me a DVD and CD for training and we should have that up and running by the end of the month.

There is only one distributor for the King to EMS and I told our sales rep they are pricing themselves out of the market. He said the price is supposed to come down by the end of the year but probably not to hospital costs. I emphasized they must get the price of three Kings to under one combitube. How many people carry both size combitubes?

We have not gotten samples of the new LTS-D for the hospital but I don't see how any size tube will pass through it because of the cap over the largest hole at the glottic opening. You have to see one to understand. But, as AZCEP said, why would you want to but in a tube that small?

Live long and prosper.

SPock