# contraindications



## soon2bemt (Aug 13, 2006)

Ok, I brought these out of my head as if I actually remember anything from EMT class......Contraindications for the combitube are as follows.....

1-conscious (DUH)
2-gag reflex
3-under 5' tall
4-over 7' tall
5-under 16 y/o
6-caustic ingestion
7-esophageal diseases

Can anyone think of any others?  I backed these up with my book-these are the only ones they mentioned......Just wondering if there were any others.


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## Guardian (Aug 13, 2006)

can't think of anymore off hand


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## MMiz (Aug 13, 2006)

I think you have 'em covered, but remember that age alone doesn't determine if someone gets one.  Age & Height really matter.


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## divinewind_007 (Aug 14, 2006)

also...cirrosis of the liver


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## soon2bemt (Aug 14, 2006)

Really?  I have never heard of the cirrosis of the liver one.  Looked it up in my book and didn't even mention it.  Maybe it will look good if I mention that one tomorrow during testing because they might think no one knows that one.


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## divinewind_007 (Aug 14, 2006)

yea....at least in tennessee it was when i took my test. I always remembered that one cause my thinking was if my patient is needing a combitube then they probably wont be able to tell me they have cirrosis of the liver.  unless your lucky enough to have a knowledgeable bystander. i just checked with my dad to make sure...hes a EMT-P/EMT instructor...and he said that at least here in TN it is a contraindication. BTW...he was also my teacher..trust me, it was a blast:glare:


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## divinewind_007 (Aug 14, 2006)

here is the skills manual for tennessee

http://www2.state.tn.us/health/Downloads/EMS_Skills.pdf


Here is the section on Combi-tube:

TN SKILLS MANUAL July 2003
DOUBLE LUMEN AIRWAY DEVICE
Combitube

GOAL
To provide adequate oxygenation and ventilation for the patient in respiratory
distress or arrest

OBJECTIVE
Given a simulated patient, the EMT student will be able to state the indications,
contraindications, and demonstrate the insertion and removal of the airway device.

INDICATIONS
Patients 16 years or older experiencing apnea or inadequate spontaneous
respiratory effort
Absence of protective gag reflex
When there is only one EMT available for transport.

CONTRAINDICATIONS
Under age 16 yrs.
Cirrhosis of the liver
Under 5 feet tall
Known esophageal disease
Over 7 feet tall
Ingestion of caustic substance
Gag reflex

EQUIPMENT
BSI Suction Device
Combitube Kit Rigid (Yankeur) suction tip
Bag Valve Mask Device (BVM) # 18 French Levine Catheter
Appropriate size Oral airway Lubricate (water soluble jelly)
Stethoscope 4x4’s
Oxygen


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## Guardian (Aug 15, 2006)

divinewind_007 said:
			
		

> also...cirrosis of the liver



I forgot about this one.  Not all medical directors agree with this however.  The reasoning behind this is that when the liver scarring causes decreased blood flow, it causes blood to seek other routes for transport back to the heart and therefore causes veins in the esophagus to become swollen.  When a large device such as the combitube is placed into the esophagus, it can damage these swollen veins and cause MAJOR life threating hemorrhage.


Some Medical Directors says use the combitube with known liver cirrhosis but not esophageal varices (swollen veins in esophagus).  Other Medical Directors advise never to use combitube with known liver cirrhosis because of the chance of varices.  I haven't seen research and would just advise following your local medical directors advise.


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## emt4life (Aug 15, 2006)

We actually carry only a small adult combitube on our trucks that can be used on people under 5 feet, the height restriction on ours is I believe 4 feet.  It is a bit shorter, more flexible and you use less air in each balloon, 85cc in #1 & 12cc in #2.  I like it, it is easier to put in and haven't had any problem using it on taller people.


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## soon2bemt (Aug 15, 2006)

So I am off to testing here in about an hour.......not really nervous-everyone is telling me that I will do great which helps.  WISH ME LUCK!!!!


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## divinewind_007 (Aug 15, 2006)

good luck...


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