Blind airway devices.

[Lannel]

Today in my EMT class we were introduced to blind airway devices. (King and combitube?). We were shown how to deflate and lubricate and insert them, as well as to check to see if air is going into the stomach for combitube or of it's going into the lungs.

My question is, I'm kinda fuzzy with when to use them. The example he gave us was when you're using a BVM and ventilating a patient who can't breathe on their own, he told us to remove he OP and insert the blind airway after giving him some 12-15 breaths per minute to pre oxygenate the patient while you switch airways. And then when you get everything setup you attach the BVM to the device.

I guess my question is when is it necessary to remove the OP AIRWAY for the blind airway?

 

[Frozennoodle]

The oropharyngeal airway, or OPA for short, is a basic airway adjunct that assists your manual airway maneuvers, think jaw thrust and head-tile chin-lift, in keeping the tongue out of the patient's oropharynx. The OPA does not prevent gastric contents, saliva, or blood from passing through the glottic opening of the trachea and causing lower respiratory compromise. Any time you have a patient with a decreased mental status, that patient has a decreased ability to protect that glottic opening. If your patient accepts an OPA without gagging, that's a good indication that they are not able to protect their airway and a supraglotic (Combi-tube or King airway) or glottic airway (LMA) should be used. The reason you insert the OPA into the patient's airway and ventilate before inserting the blind insertion device is two fold: 1. You are assuring that there is no gag reflex present and 2. It will help you keep the airway open while you oxygenate your patient. Remember this patient's blood is not carrying as much oxygen as it normally would because they are not breathing adequately or their airway has been compromised and oxygen was not able to reach the alveoli. Because the patent is de-oxygenated, or hypoxic, the patient must be oxygenated as soon as possible while you are setting up and deploying the supraglotic or glottic airway.

Remember that Combi-tubes, LMA's, and King LTD airways do not completely secure the lower airway but do significantly reduce the risk of aspiration, or fluid being sucked into the patient's lungs. Contraindications, reasons for not using these devices, include caustic substance ingestion, any type of burns to the face or airway (chemical, thermal, or otherwise) known esophagus disease or prolonged alcohol abuse, and the presence of an intact gag reflex.

 

[LACoGurneyjockey]

Exactly what he said.
In short, whenever your patient cannot protect their own airway. If you can bag with an OPA, you can and should insert a King/Combi/LMA. It's just a more secure way to ventilate your patient.

 

[jcroteau]

Further to your post.......what are your guys thoughts on intubation after caustic substance ingestion?? My medic school instructors keep saying it will melt the tube.....how would you then manage the airway??

 

[RedAirplane]

Follow up question: when would you stop to use an OPA/NPA or any sort of airway device? Adult arrests tend to be full arrests, in which case the priority is chest compressions and sending someone to look for an AED...

 

[chaz90]

Follow up question: when would you stop to use an OPA/NPA or any sort of airway device? Adult arrests tend to be full arrests, in which case the priority is chest compressions and sending someone to look for an AED...

When there are multiple people working the arrest, and there typically are, one is doing compressions, one is setting up the AED, and one (possibly plus one more to hold the seal of the BVM) is managing the airway. Part of managing the airway means getting out an OPA and placing it in between ventilations. If you're somehow alone, compressions plus AED usage as you can would be plenty impressive.

 

[Carlos Danger]

Further to your post.......what are your guys thoughts on intubation after caustic substance ingestion?? My medic school instructors keep saying it will melt the tube.....how would you then manage the airway??

Are they saying that patients who have ingested caustic substances should never be intubated?

 

[Brandon O]

Are they saying that patients who have ingested caustic substances should never be intubated?

And what are the odds of someone drinking lye AND being blind?

To the OP: while in theory, most patients CAN be ventilated with a BVM alone (and oral or nasal airways are always a good idea with the BVM), in practice it can be difficult to do and even then has a habit of going down the wrong hole -- i.e. into the belly. The number one benefit of a blind rescue airway is probably that it's a quick replacement for bagging that avoids gastric distention.

 

[COmedic17]

Further to your post.......what are your guys thoughts on intubation after caustic substance ingestion?? My medic school instructors keep saying it will melt the tube.....how would you then manage the airway??

If they don't have a secure airway, they are going to die.

Tube them. It's not gonna get any worse then not having an airway. Oxygen is pretty important for survival.


There's very few substances that will "eat away" a tube. And in that case, all the tissue will be "eaten away" too. They are not going to be any worse off.

It's silly to say "don't do it. It might eat the tube"....... Will they die if the tube disintegrates in their trachea? Probably. But they are going to die if they don't have a patent airway as well.

 

[Carlos Danger]

If they don't have a secure airway, they are going to die.

Tube them. It's not gonna get any worse then not having an airway. Oxygen is pretty important for survival.

Caustic ingestion is not by itself an indication for intubation.

It's not a contraindication, either. Though I do think it's a better argument for a conservative approach than an aggressive one.

Bottom line is that you treat a caustic ingestion like any other patient. If there are clinical indications for airway securement, follow your airway protocol. If there are no clinical indications, then don't worry about it.