# Esophageal Airway



## JJR512 (Feb 22, 2011)

I like to watch reruns of _Emergency!_ whenever I can, which are shown daily on the RTV (Retro Television) network at 3pm (check local listings).

On the show, they frequently talk about an "esophageal airway". For example, Johnny or Roy will contact Rampart and the doc there will instruct the squad crew to start or place an esophageal airway.

What the heck is an esophageal airway? The term implies it goes into the esophagus but if you put an airway into the esophagus, wouldn't you just end up inflating the stomach?


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## EMSrush (Feb 22, 2011)

I've never seen the show, but I would assume that they are referring to a multi-lumen airway that can be inserted blindly (usually into the esophagus, hence the nickname) such as a Combitube or a King Airway.


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## reaper (Feb 22, 2011)

Its an EOA. Not used much any longer. Basically the same design as a king.


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## JJR512 (Feb 22, 2011)

Is the concept that you plug up both the esophagus and the mouth/nose, so that when you provide air (O2) through the tube going into the mouth, it has no other place to go except into the lungs via the trachea?


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## NomadicMedic (Feb 22, 2011)

It was the EOA, a blind insertion device, but it had a mask along with it.







There was also it's close cousin, the EGTA, Esophageal Gastric Tube Airway, allowing for gastric decompression.






When I first became an EMT-I back in the late 80's, these were the airways we were allowed to use. Even then my instructor called the EOA the "essentially obsolete airway".


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## EMSrush (Feb 22, 2011)

Oooo! How cool! Thanks for the pictures!!


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## EMSrush (Feb 22, 2011)

JJR512 said:


> I like to watch reruns of _Emergency!_ whenever I can, which are shown daily on the RTV (Retro Television) network at 3pm (check local listings).



How old is this show? Personally, I've always been a "Rescue 911" girl myself. Loved William Shatner....


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## TransportJockey (Feb 22, 2011)

Heh EOAs... I trained on those and PTLs when I was in basic class in 07 in NM. I think only one or two services still has any on the truck.


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## JJR512 (Feb 22, 2011)

EMSrush said:


> How old is this show? Personally, I've always been a "Rescue 911" girl myself. Loved William Shatner....



1972-1978

My signature is a quote from the show.


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## usalsfyre (Feb 22, 2011)

Ahh yes, the "airway" that still required the user to maintain a mask seal. Good times...


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## Veneficus (Feb 22, 2011)

usalsfyre said:


> Ahh yes, the "airway" that still required the user to maintain a mask seal. Good times...



right there with you.


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## reaper (Feb 22, 2011)

Come on, we all miss those days! Haha


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## Akulahawk (Feb 22, 2011)

I remember the EOA/EGTA... Thankfully, I've never had to use one of those, though I was trained in how to. Back when, the LMA was just starting to hit the field and the Combitube was also starting to become popular.


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## cfrench (Feb 23, 2011)

Yeah EOAs required you to maintain a mask seal but if you ran codes with no advanced airway options, the EOA was a GODsend. Immediately you did not have to worry about vomitus and only an idiot would put one in wrong (unfortunately there was an unacceptable amount of idiots out there I guess). I do find the Kings to be EOA 2.0  I kind of chuckle a bit when people make like they were tools of the devil. I need to bring them back to the very early 80's.


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## EMSrush (Feb 23, 2011)

I checked out Retro TV to see if I could find Emergency! because I've never watched that channel or show before.... 

Unfortunately, hubby was in the room at the time, and he hasn't changed channel since I turned it on. Thanks a lot!! How much more Knight Rider, Magnum and A-Team can I possibly watch!?


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## abckidsmom (Feb 23, 2011)

EMSrush said:


> I checked out Retro TV to see if I could find Emergency! because I've never watched that channel or show before....
> 
> Unfortunately, hubby was in the room at the time, and he hasn't changed channel since I turned it on. Thanks a lot!! How much more Knight Rider, Magnum and A-Team can I possibly watch!?



It's also on Netflix instant watch.  I love to hear my 3 yo say, "They're getting a call!  They've got to go now."

I just found a PTL cleaning out a closet at our station week before last.  We moved into this station in 1994, I'm not sure when we stopped using them.  Pretty sure combitubes were the only blind airway device from at least 1998 on until Kings came out.


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## Veneficus (Feb 23, 2011)

I never found the EOA to be particularly useful.

Even the current esophageal airways don't seem to be something to write home about. It is not like adequete ventilation cannot be obtained without them, and the patient usually aspirated what they were going to prior to putting one in anyway in my experience.


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## cfrench (Feb 23, 2011)

Veneficus;284088ul.
 patient usually aspirated what they were going to prior to putting one in anyway in my experience.[/QUOTE said:
			
		

> You Really had to get there before much CPR was started. That was way before EMD so you usually lucked out and everybody was standing around. Of course, none of these patients were saved back them it seems. I am not sure the EOA really helped the pt very much but it made our lives so much easier. This was long before any BSI stuff, gloves were rarely if at all worn and we did not even have masks.
> 
> Sorry, just the dying gasps of an EMS Dinosaur


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## MEDIC802 (Feb 23, 2011)

I too remember to day of doing mouth to mouth, stopping long enough to spit the pt's vomit from your mouth and then continuing, I remember using the EOA, always had a problem with snapping the mask in place and ,holding a good seal, Is it not blasphmy to work in ems or the fire service and have NO knowledge of John G and Roy D,this should be required watching material, even though sodium bicarb is no longer a front line drug.


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## usalsfyre (Feb 23, 2011)

MEDIC802 said:


> Is it not blasphmy to work in ems or the fire service and have NO knowledge of John G and Roy D,this should be required watching material, even though sodium bicarb is no longer a front line drug.



No matter what was wrong, a line with D5W, 1 amp of Bicarb and a 100mg Lidocaine bolus followed by a drip at 2mgs/min would fix it.


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## cfrench (Feb 23, 2011)

usalsfyre said:


> No matter what was wrong, a line with D5W, 1 amp of Bicarb and a 100mg Lidocaine bolus followed by a drip at 2mgs/min would fix it.



And don't forget, the IV has to be in a glass bottle


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## foxfire (Feb 23, 2011)

usalsfyre said:


> No matter what was wrong, a line with D5W, 1 amp of Bicarb and a 100mg Lidocaine bolus followed by a drip at 2mgs/min would fix it.


Seriously ? Wow


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## NomadicMedic (Feb 23, 2011)

I loved emergency as a kid. It's on Hulu.com now. I watch it when I'm bored. 
Some of the gems; 2 amps of bicarb for arrests, intracardiac epi, EOAs, and shocking every patient back into NSR. If only it were that easy now.


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## Veneficus (Feb 23, 2011)

MEDIC802 said:


> I too remember to day of doing mouth to mouth, stopping long enough to spit the pt's vomit from your mouth and then continuing, I remember using the EOA, always had a problem with snapping the mask in place and ,holding a good seal, Is it not blasphmy to work in ems or the fire service and have NO knowledge of John G and Roy D,this should be required watching material, even though sodium bicarb is no longer a front line drug.



Johnny and Roy helped inspire my career, but i think missing out on mother, juggs, and speed would be more unholy.


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## Akulahawk (Feb 23, 2011)

Mother, Juggs, and Speed? Missing out on that is the _definition _of unholy! Missing it is MOST Blasphemous!


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## jjesusfreak01 (Feb 23, 2011)

My instructor pulled out both of these retro airways during my EMT class. He also did a class on picc lines, ostomies, shunts, etc...he wanted us to not be surprised with anything.


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## JJR512 (Feb 24, 2011)

And every patient on _Emergency!_ always survived if they were treated by Johnny and Roy...unless it made a dramatic, or more importantly a sociological commentary point, to have the pt. die.


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## MasterIntubator (Feb 24, 2011)

Veneficus said:


> I never found the EOA to be particularly useful.



I would have to disagree...  I found the EOA a wonderful device for the time.  Having placed numerous of them... they gave me great frustration in maintaining a good facial seal( good for training skills ), allowed copious useage of Kentucky Jelly ( which I always loved lubing up  ), it plugged the puke hole so nothing would ever come out, it was nice to intubate around, it provided a great bite block for the ETT, it gave you something else to do while doing CPR in the checkout line at a grocery store to look cool for the crowds watching ( just under flipping the abboject caps off and defib with paddles with the lifepak 4/5. ) and it came in a great big, space occupying white and yellow box that no one can miss.

Just about everything just short of good ventilation.   :blush: :wacko:


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## abckidsmom (Feb 24, 2011)

MasterIntubator said:


> I would have to disagree...  I found the EOA a wonderful device for the time.  Having placed numerous of them... they gave me great frustration in maintaining a good facial seal( good for training skills ), allowed copious useage of Kentucky Jelly ( which I always loved lubing up  ), it plugged the puke hole so nothing would ever come out, it was nice to intubate around, it provided a great bite block for the ETT, it gave you something else to do while doing CPR in the checkout line at a grocery store to look cool for the crowds watching ( just under flipping the abboject caps off and defib with paddles with the lifepak 4/5. ) and it came in a great big, space occupying white and yellow box that no one can miss.
> 
> Just about everything just short of good ventilation.   :blush: :wacko:



Oh, the lifepak 5!  I loved watching that needle bounce around as it recorded artifact for at least the next week or two before the paper faded!

One of the first arrests I can remember was a drunk guy who dove off a platform into 2.5 feet of water.  We had a 20 minute response time, and got on scene to find a bunch of drunk guys doing CPR, on that platform out in the water.  We hoisted the bag and the monitor and the drug box up overhead and splashed on out there.  

We were really herioc bag then.  And completely effective!  That guy even had the helicoptor called for him, another 20 or so minutes later.  IVR was the gift that kept on giving.

In my defense, I was a junior...not in charge, and I only remember this call as an illustration for how much money and time was wasted on people without a hope.


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## Veneficus (Feb 24, 2011)

MasterIntubator said:


> I would have to disagree...  I found the EOA a wonderful device for the time.  Having placed numerous of them... they gave me great frustration in maintaining a good facial seal( good for training skills ), allowed copious useage of Kentucky Jelly ( which I always loved lubing up  ), it plugged the puke hole so nothing would ever come out, it was nice to intubate around, it provided a great bite block for the ETT, it gave you something else to do while doing CPR in the checkout line at a grocery store to look cool for the crowds watching ( just under flipping the abboject caps off and defib with paddles with the lifepak 4/5. ) and it came in a great big, space occupying white and yellow box that no one can miss.
> 
> Just about everything just short of good ventilation.   :blush: :wacko:



Clearly I underestimated its value.


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## MonkeySquasher (Feb 24, 2011)

Heh...  NYS requires Medics to still be trained in EOA/EGTA, Combitube, LMA< and other obsolete airways.  We also train on both old and newer monitors.

I belong to two services, one uses LP12, the other Zoll M.  And I still think the LP10 is one of the best monitors ever.  Simple, effective, very straightforward, has paddles but can convert to handsfree.


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## NomadicMedic (Feb 24, 2011)

MonkeySquasher said:


> And I still think the LP10 is one of the best monitors ever.  Simple, effective, very straightforward, has paddles but can convert to handsfree.



I'm guessing you don't do 12 leads.  (Unless you do the old MCL trick.)


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## usalsfyre (Feb 24, 2011)

MonkeySquasher said:


> Heh...  NYS requires Medics to still be trained in EOA/EGTA, Combitube, LMA< and other obsolete airways.  We also train on both old and newer monitors.
> 
> I belong to two services, one uses LP12, the other Zoll M.  And I still think the LP10 is one of the best monitors ever.  Simple, effective, very straightforward, has paddles but can convert to handsfree.



Considering that tomorrow out of all the patients placed under general anesthesia the majority will have a LMA placed to facilitate ventilation and provide airway protection I'm not sure I'd consider it "obsolete". 

I miss the LP10 sometimes. You could nearly run over the darn thing and not break it. However I can't say the 12 isn't a superior diagnostic device. I never did like paddles though.


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## MEDIC802 (Feb 24, 2011)

One service I work for uses the Zoll E series with all the bells and whistles, the other service still uses the LP 10, but that finally gonna change, state is gonna require 12 leads and ability to transmit on all ALS transport units by end of year.
 The first monitor I ever used was an MD3.


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## MonkeySquasher (Feb 24, 2011)

usalsfyre said:


> Considering that tomorrow out of all the patients placed under general anesthesia the majority will have a LMA placed to facilitate ventilation and provide airway protection I'm not sure I'd consider it "obsolete".



You're right, I'm sorry, I didn't specify.  The LMA is obsolete as a pre-hospital airway.  It is useful as a temporary airway in a stable environment, but has too many contraindications and doesn't protect the airway well enough for an emergency airway, IMO.

The others are obsolete due to advancements and improvements.

And you're right, the LP10 can't do a 12-lead, nor ETCO2 or SPO2...  But it's a great monitor.


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## JLMooreKCMO (May 26, 2013)

usalsfyre said:


> Ahh yes, the "airway" that still required the user to maintain a mask seal. Good times...


I actually used them all the time in the 80's worked quite well. The Paramedics in CA could not intubate until sometime in the 90's but yet had the highest save rate in the country, probably due to time & preventing aspiration.I could insert an EOA in about 3-5 seconds. As far as seal they were made with a extremely plyable material seal was never a problem.


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## Handsome Robb (May 27, 2013)

MonkeySquasher said:


> You're right, I'm sorry, I didn't specify.  The LMA is obsolete as a pre-hospital airway.  It is useful as a temporary airway in a stable environment, but has too many contraindications and doesn't protect the airway well enough for an emergency airway, IMO.
> 
> The others are obsolete due to advancements and improvements.
> 
> And you're right, the LP10 can't do a 12-lead, nor ETCO2 or SPO2...  But it's a great monitor.



I might be wrong but don't most services in Australia use the LMA at the ILS level. I know ICPs can intubated but I don't think their standard Paramedics can. If I'm not mistaken about this whole thing they seem to work fine for them otherwise they wouldn't use them anymore...with that said, there's a TON we can learn from those Auzzies and Kiwis when it comes to EMS


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## Carlos Danger (May 27, 2013)

MonkeySquasher said:


> You're right, I'm sorry, I didn't specify.  *The LMA is obsolete as a pre-hospital airway.*  It is useful as a temporary airway in a stable environment, but *has too many contraindications and doesn't protect the airway well enough* for an emergency airway, IMO.
> 
> The others are obsolete due to advancements and improvements.
> 
> And you're right, the LP10 can't do a 12-lead, nor ETCO2 or SPO2...  But it's a great monitor.



I'm curious which contraindication you refer to that don't apply to other SGA's, and also which other SGA protects the airway better than an LMA?

I definitely wouldn't call the LMA obsolete. And it most certainly doesn't belong in the same category as the EOA and Combitube.....even if for no other reason than that it's still widely used. 

You might be able to make a good case that the King or another SGA is better for general prehospital use for some reason, and that's fine, but the LMA is a great tool that remains the standard against which all other modern SGA's are measured. 

Personally, an intubating LMA will probably always be my backup airway for an emergent situation, whether I'm in the ambulance, the helicopter, or the OR. At least until I'm convinced that something else is better.


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## Flight-LP (May 27, 2013)

Halothane said:


> I'm curious which contraindication you refer to that don't apply to other SGA's, and also which other SGA protects the airway better than an LMA?
> 
> I definitely wouldn't call the LMA obsolete. And it most certainly doesn't belong in the same category as the EOA and Combitube.....even if for no other reason than that it's still widely used.
> 
> ...



This!

I'd take an LMA Supreme over a King any day.


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## Rayon (Jul 3, 2013)

*Emergency (TV show)*

Interestingly enough I am currently watching an episode of this show (via Netflix btw) and I too was wondering what they were referring to as the Esophogeal Airway.  A google search landed me on this forum.  

Emergency (the show) was popular back in the early to mid 70's, so that's when I watched it.  The good news for you buffs out there you can watch it ad naseum via Netflix.  =-D 

I assumed they meant the old EOA or EGTA, but wanted to see if there was something specifically tied to "Esophogeal Airway".  

Anyway that's my 2 cents.


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## Milla3P (Jul 5, 2013)

reaper said:


> Its an EOA. Not used much any longer. Basically the same design as a king.



EOAs are required on every ambulance in my state. Frontline BLS "advanced" airway. Add that they don't have expiry dates on them and you can imagine how old some of these suckers are.


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## TransportJockey (Jul 5, 2013)

Milla3P said:


> EOAs are required on every ambulance in my state. Frontline BLS "advanced" airway. Add that they don't have expiry dates on them and you can imagine how old some of these suckers are.



Really? Our frontline bls airway are LMA, King, or Combi. I can't imagine being forced to use an EOA.


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## Milla3P (Jul 5, 2013)

It's very rare to find a BLS trick on the road. Even for BLS transport. Our OEMS is just a little slow to act...


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