The final word on combitubes

[Dustdevil]

Our placement was good, bi-lateral breath sounds and nothing in the abdomen. The first 3 pumps on the bag filled up the belly.

Huh? :?

[brentoli]

Late night post - I need to proofread better.

First 3 pumps after the ETT was placed and the combi-tube was removed. The medic never could secure his airway and get good lung sounds the whole trip in approximately 15 min after ALS arrival.

[croaker260]

Part of our trainign and education on this for our medics is reviewing the research, part of wich shows great blood gasses after 4 hours on the combitube. We also discuss the airway edema that occurs durign routine combitube placement, emphasizing that it will be a difficult tube at best.

Therefore, since there is no good reason to replace it once its in (assuming it is working), leave it and move on to other important tasks.

We had to do the same thing for our local docs as well. Than and had to convinve them that the "pull the onion from the ground" method of removal wasnt the best either.

BTW, simply cutting the cuff lines DOES NOT completely deflate the combitube....only removing the air with a syringe does.

And DUST, I am so lost as to your point that I dont even know where to begin. Could you start with explaining how me thinking that EMT B's need more hours in their instruction before any more skills/scope are even considered , whether you call it education or training, means I dont support education?

I am beginning to think you are just trying to start an argument...for argument sake.

[Spock]

I have never liked the combitube because I hate having to go down to the ER to change one. The ER docs won't touch it and they always call anesthesia to change it. That feeling aside, it is a reasonable backup airway to a failed intubation. Each time I have changed one I have found the patient is adequately ventilated and oxygenated so the change to an ET tube is done slowly and carefully. Most of the combitubes I have changed were placed by flight crews on trauma patients after failed RSI. I have never changed a combitube on a cardiac arrest patient unless they get pulses back.

I have said before that I like the King and have been using it in the OR since March 2006. I have quit using the LMA in favor of the King. One of our local flight services added the King and tracked the use of both it and the combitube. After 6 months they removed the combitube and use the King as the primary rescue airway. I believe the LMA would easily lose its seal when the patient is moved in the prehospital arena.

The depth of anesthetic required for a King is greater than that required for an LMA which is one down side. The term conscious sedation was used in conjunction with the LMA and I would suggest this is erroneous. Conscious sedation means the patient retains their gag reflex which precludes the use of an LMA, ETT, King or combitube. Once you lose the gag reflex you move into the realm of general anesthesia for which one must be properly credentialed.

I also believe that the King could be a BLS skill with proper education and training along with a close and stringent QI/QA process. If you can place an OP airway you can place a King.

Live long and prosper.

Spock

[somedic]

I dont think its a good idea to give ambulance drivers Combitubes. We as a country would never give a country like Sudan nuclear weapons so it stands to reason that ambulance drivers need to go to Paramedic school if that want to be educated in airway management beyond the BASIC level.

Somedic Sends

[Dustdevil]

We as a country would never give a country like Sudan nuclear weapons...

Is there anybody even left in Sudan?

From where I sit, it looks like they all up and moved to Iraq.

Sudanese are the Mexicans of Iraq.

[mobey]

I dont think its a good idea to give ambulance drivers Combitubes. ambulance drivers need to go to Paramedic school if that want to be educated in airway management beyond the BASIC level.

Somedic Sends

Do all the basics just drive in your area, or are you just degrading them for sport and to assist the general public in holding back EMS as a profession?

[katbemeEMT-B]

I work in a all BLS system. The only ALS option for us Air Care right now. They are working on placing an ALS chase car in our area but we have been waiting since March and still nothing. I'll let you know how that goes when and if it ever happens. Anyway, we are able to use the combitube but had to attend not only training on how to use it but also classes on airway structure and respiratory determination. I do agree that it is a very limited tool and many times the patient would benefit from a higher level of care. Unfortunately, right now, we don't have that option. In most cases it will take an Air Care medic 8 to 10 minutes to reach us. The hospital is within 6 to 10 minutes from us. What we were taught is to start with the BVM and simple adjunct first. The combitube is reserved for unconscious patients that we are having difficulty bagging. I can say that in the last year, I have never used a combi but I have used an oral adjunct. As a basic, I still don't feel educated enough to use a combi even though I went through the initial training and education and also have had follow-up training. I know that if it came down to it, I could do it, but in all honesty, I don't want to. I would rather leave that to the medic. But, let's also remember that this is just me. Not all EMTs may feel this way.

My answer is, send us all back to school for another two years and then unleash us in your communities. The education of an EMT-B truly is sad and as a basic I feel cheated. A better educated basic means better patient care.

[Dustdevil]

Do all the basics just drive in your area, or are you just degrading them for sport and to assist the general public in holding back EMS as a profession?

Education holds back the EMS profession?

That's a novel theory.

Care to expand on that for us?

[mobey]

Education holds back the EMS profession?

That's a novel theory.

Care to expand on that for us?

Sorry I apparently worded that poorly

It seems pretty degrading to me to be calling BLS emergency service professionals "ambulance drivers" (unless that's all your basics do like our EMR's).