# Combi-Tube vs ET tube?



## c-spine (Jun 25, 2006)

What's the difference in a Combi-tube and an ET tube? Don't they both go to the same place?  (Yes, I know - I should know this)  :blush:


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## DT4EMS (Jun 25, 2006)

c-spine said:
			
		

> What's the difference in a Combi-tube and an ET tube? Don't they both go to the same place?  (Yes, I know - I should know this)  :blush:



The ET (EndoTracheal) is supposed to go into the trachea with direct visualization. I say supposd to because the number 1 patient care realted issue in EMS is airway.

The Combi-Tube is a blind isnertion type device. The way it is designed to work is; more likely than not a tube inserted into a patients mouth will go into the esophogus. The Combi-Tube has the ability to ventilate a patient indirectly( by bloacking off the esophogus) and directly into the trachea. An ETT ventilates directly into the trachea. 

Kinda short response I know, but it is much easier to "show you" how it works.


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## c-spine (Jun 25, 2006)

-thinks for a minute-

Ok, it makes sense. I knew ET meant endotracheal, but I couldn't figure out the difference... hehe... long day. x.x


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## Ridryder911 (Jun 26, 2006)

Basically add this.... ETT gold standard, nothing better. Combi-tube, alternative airway when you can not get someone intubated....

R/r 911


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## fm_emt (Jun 26, 2006)

... and, in some areas, an EMT-B can intubate with a combitube. 

Although I'm not entirely sure if it's *only* a combitube or if they actually cover the ET tube intubation as well. 

Our county is not one of those counties, but I believe that some counties up in far northern California allow it.


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## joemt (Jun 26, 2006)

I don't think it's called "intubation" when you place a Combi-Tube.. but, honestly I don't know.... I don't want my students thinking that they are "intubating" when they insert this or any other BLS device.


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## fm_emt (Jun 26, 2006)

joemt said:
			
		

> I don't think it's called "intubation" when you place a Combi-Tube.. but, honestly I don't know.... I don't want my students thinking that they are "intubating" when they insert this or any other BLS device.



I was using the literal definition which is "To insert a tube into a hollow organ or body passage."

I think that a combitube would count, as it's a tube, and the esophagus is a hollow body passage. Once I go through the class, I'm sure I'll have a better idea. I better, anyway! 

I'll shut up now. ;-)


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## Wingnut (Jun 26, 2006)

Do you all still use the "regular" ET tubes? They switched us to King tubes several months ago.


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## emtbuff (Jun 26, 2006)

We had an inservice at the hospital covering Airways last week.  It was the first time I had seen a king LT.  Which looked alot like a combitube.  Just smaller, and used only 1 syringe.  I know they still use ET tubes.  Now a question for others as the flight nurse giving the inservice said not to use the LMA as a doctor that does Locum here decided that is what he wanted and so of course we got them.  Oh and he wanted them for Code situations.  We were told to not use them as they don't protect the airway addequately enough like the combi, ET, or King LT would.  We were told that the LMA's worked well in a surgical setting but other then that to not use them.

So I guess with all this rambling I'm asking are you allowed to use LMA's or not??

I think the nursing department decided that we would not be grabing for that one as a primary airway.


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## joemt (Jun 26, 2006)

Our flight Medics and Nurses here LOVE LMA's


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## c-spine (Jun 26, 2006)

Lma.... ???


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## emtbuff (Jun 27, 2006)

LMA--laryngeal Mask Airway

Joemt- do they have a problem with aspiration??  I think that was the main concern when we were talking about them here.


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## joemt (Jun 27, 2006)

Honestly, I don't know.... I'll have to ask our Flight Team.... I'll let you know.


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## Ridryder911 (Jun 27, 2006)

LMA's have proven to be very unstable on the field arena. Yes, they are easy to insert, and use the problem is the stability... they pop out. Many have quit using them because of this.. 

King airways are a modified combi-tube.. 

R/r 911


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## Ridryder911 (Jun 28, 2006)

For those that want to see what a LMA looks like here video I posted. This is a conscious intubation with one, and a whistler attachment.. (* Please do not attempt this at home, trained professional 

http://www.youtube.com/watch?v=HXjPdNSL96c&search=intubation


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## gradygirl (Jun 28, 2006)

This might be veering off topic a little bit, but is it possible for someone to self-intubate? According to local EMS lore, a good friend of mine got pissed off at a drunk pt. and made the guy intubate himself. :huh:


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## Ridryder911 (Jun 28, 2006)

Need to make a bet on that one.. Although I have seen many people without a "gag" reflex ( no other comments) it is very hard to intubate a non-responsive versus an awake. One needs to be very careful as well not to cause laryngospasm with the touching of chords, or epiglottis. 

For as self intubating... total B.S. Someone shooting of remarks from the wrong end, don't be gullible.....


R/r 911


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## c-spine (Jun 29, 2006)

How that woman didn't move... I would have been coughing and gagging and swinging at whoever was trying to put that down my throat!!


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## gradygirl (Jun 29, 2006)

c-spine said:
			
		

> How that woman didn't move... I would have been coughing and gagging and swinging at whoever was trying to put that down my throat!!



No kidding. And the whistling sound the tube made would have freaked me out.


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## c-spine (Jun 29, 2006)

LOL... yeah... I would have self un-intubated really quickly, doctors orders or no.


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## Ridryder911 (Jun 29, 2006)

If you noticed that they lidocaine injected in the neck.... it was a neurosurgery so the patient had remain awake...

R/r 911


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## gradygirl (Jun 29, 2006)

well, self intubation may be total b.s., but self extubation is a very possible situation, though i'm sure very regrettable after the fact.


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## Ridryder911 (Jun 29, 2006)

That is why protocols should include restraints and additional sedation and paralytics for patients awakening.
R/r 911


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## KEVD18 (Jul 1, 2006)

while useful as a last ditch effort, as a secure airway the combitube doesnt cut it. the probability of you sucessfully intubating the trachea is very small, so you'll be in the esophagus by default. esophageal obturation is not a secure airway

if your a basic who dropped a c-t prior to the arrival of the als crew, you have just changed the whole dynamic if the call. medics, at least not the medics i work with, wont push drugs down a c-t. and they cant/wont pull your c-t to place an e-t due to the high probability of airway trauma preventing the ett placement. and they wont be happy be4cause they dont have a 100% secure and patent airway.

sont even get me started on the lma


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## RALS504 (Jul 9, 2006)

Combitubes have thier place in EMS. 
Pros
-all EMTs can place one
-great rescue airway when ET tube can not be placed
-effective 

Cons
-can't push med through unless you have tracheal placement
-it is supose to only be in place 8 hours or less
-it is some what of a secured airway from emesis, but not from 
-tracheal/epiglotis swelling

If you are an EMT and you do not have intubation privilages placing a combitube on a pt is probably appropriate. I am not advocating dropping a combitube as your ALS unit is pulling in the driveway of the scene. But if you are intercepting ALS and you are five minutes away or more then place your combi tube.


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## brentoli (Aug 8, 2006)

KEVD18 said:
			
		

> while useful as a last ditch effort, as a secure airway the combitube doesnt cut it. the probability of you sucessfully intubating the trachea is very small, so you'll be in the esophagus by default. esophageal obturation is not a secure airway
> 
> if your a basic who dropped a c-t prior to the arrival of the als crew, you have just changed the whole dynamic if the call. medics, at least not the medics i work with, wont push drugs down a c-t. and they cant/wont pull your c-t to place an e-t due to the high probability of airway trauma preventing the ett placement. and they wont be happy be4cause they dont have a 100% secure and patent airway.



So you are saying that if I have a code, and ample manpower, not to drop a combi when my ALS truck is still miles away?


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## c-spine (Aug 8, 2006)

I don't think that's what was meant... if it's going to save the patient's life... do it. If your truck is a few miles out and your patient is coding... go to combi tube.


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