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Thu, 14 Mar 2002 06:15:19 -0500

Reading with interest the commentary on the Combi-Tube.  To quote Spock:
"Fascinating."

What is the consensus for the management of the airway in the case that ETT
cannot be done for (**insert reason here...unable to visualize, clenched
teeth w/o RSI, funky anatomy, poor skill of the medic, etc.**)???

Please assume a 20 minute transport, no helicopter available, limited
resources (call it two people in the back of the ambulance,) and no MD on
the scene.

Interested to hear what y'all think.  It just might help me treat my
patients a little better.  For the record, I like the ETT first, and the
Combi-Tube as my bail-out device.

Best,

Jeff Brosius
Paramedic, etc.
Atlanta, GA
medic245@mindspring.com
"The fate of the wounded rest
in the hands of the one that
applies the first dressing."
-- Nicholas Senn, 1896

----- Original Message -----
From: "Holmes John" <Jholmes@mater.org.au>
To: <trauma-list@trauma.org>
Cc: "Ian Seppelt" <SeppelI@wahs.nsw.gov.au>
Sent: Wednesday, March 13, 2002 6:35 PM
Subject: Re: Combitube

> I agree, I think combitubes are inappropriate and dangerous given the
> infrequency that they would be used.  However, the LMA is not a definitive
> airway either - especially in emergent situations.  Paramedics must
realise
> that ETT is always the gold standard -  any other artificial airway (other
> than cuffed crich) is always a compromise and should ONLY be used to
> retrieve a situation where there is no other way of ventilating.  Bag and
> valve ventilation (spont or controlled) is an OK short term measure in
most
> cases - but fundamentally, if an artificial airway and positive pressure
> ventilation is mandated by the clinical scenario, then a cuffed ETT is the
> only way to go.
>
> John L Holmes
> Director Emergency Medicine
> Mater Health Services, Brisbane
>  ----------
> From: Ian Seppelt
> To: ncielens@bigpond.com; trauma-list@trauma.org
> Subject: Re: Combitube
> Date: Wednesday, 13 March 2002 19:50
>
> Simple answer - they are big nasty dangerous things with major
complications
> and there is a much better alternative (the laryngeal mask airway).
> Considered by the NSW Ambulance and rejected as inappropriate and
dangerous.
> I wouldn't go near the bloody things if I were you
>
> Cheers,
> Ian Seppelt
> Staff Specialist in Anaesthesia and Intensive Care
> Nepean Hospital, Sydney, and
> Flight Physician, NRMA Careflight.
>
> >>> ncielens@bigpond.com 03/06/02 01:42pm >>>
> Hello all,
>
> Late last year there was a thread on pre-hospital airway management by
> paramedics. I am about to write a paper on the suitablility of the
Combitube
> (double-lumen oesophageal tracheal airway) for my ambulance service in
> Victoria Australia as part of my final year of training. I am after
> information from other services who use the Combitube. In particular, I am
> after their protocols (guidelines) for its use, including emergency
> indications, precautions, contra-indications and method of insertion. If
you
> also have any stats on its success (or lack of) and other problems (or
> advantages) encountered from its use, it would be greatly appreciated.
>
> As this topic has already been covered before please feel free to email
> directly to me or the mailing list as you see fit.
>
> Thanks in advance.
>
> Nanto Cielens
> Ambulance Paramedic
> Metropolitan Ambulance Service
> Victoria, Australia
>
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