PROCEDURE:

• Undertake universal precautions.
• Place the patient in the supine position, in a patient with a suspected cervical spine injury, stabilization of the head and neck should be insured whenever Combitube is to be inserted.
• Select appropriate tube size
  • Combitube SA: patients 4 ft-5 ½ ft tall.
  • Combitube: Patients greater than 5 ft tall.
• Test cuffs and lubricate with water-soluble jelly.
• Place the patient head in sniffing position with the head hyperextended and the neck flexed (unless contraindicated by a suspected cervical spine injury) and with your free hand hold the occiput of the head to maintain the correct position.
• Assistance of a second rescuer may be necessary to open patients mouth by lifting the jaw forward and in suspected cervical spine injury keeping the neck in neutral position.
• Insert Combitube to the indicated depth, do not force.
• Inflate the pharyngeal cuff with 100 ml of air and the distal cuff with 10-15 ml of air.
• Ventilate through primary tube #1 and evaluate lung ventilation (breath sounds, gastric sounds, chest rise, end-tidal carbon dioxide, oxygen saturation.).
• If lung ventilation is absent, immediately ventilate through secondary tube #2, and re-evaluate ventilation.
• If no lung ventilation, then deflate cuff#1, withdraw Combitube 2-3 cm, reinflate cuff and re-evaluate ventilation through tube #1.
• Attach Wave form Capnography if available to confirm effective ventilation and oxygenation.
• Once effective ventilation is confirmed, continue to monitor oxygen saturation and ventilate to the desired carbon dioxide level.
• If unable to ventilate with Combitube, remove device, hyperventilate with BVM for 2 minutes.
• Re-insert the device, if still unable to ventilate refer to cricothyoidotomy protocol.

MEDICAL DIRECTOR

Contact medical control as soon as possible.

CONTRINDICATIONS

• Responsive patient with intact gag reflex.
• Patient under 4 ft tall.
• Patient under 8 years old.
• Known esophageal disease or ingestion of caustic substance.