Well-trained paramedics can successfully perform emergency uncomplicated tracheal intubations during in-hospital care but when it comes to prehospital care things may become more difficult. For instance, this woman had no neck and the paramedic had little time to work with her because her condition was starting to deteriorate. The patient also had a lot of secretions in the airway and in any condition that can cause an obstruction of the airway will make intubation and ventilation difficult. Neck mobility is a vital requirement for successful intubation. Patients in a hard collar neck immobilization obviously have no neck movement and therefore are harder to intubate.
A laryngeal mask
poled camera
cambo 4x5Alternative airway devices such as the laryngeal mask airway (LMA) or the esophageal tracheal combitube are acceptable airway devices that may be useful alternatives to tracheal intubation. In this case the combitube was used. The Combitube is a double-lumen tube with one blind end which functions as an esophageal airway and the other as a standard cuffed ET tube. It is inserted blindly and "seals" the oral and nasal pharyngeal cavities. The Combitube provides a special oropharyngeal balloon for sealing of the oral and nasal cavity. As a benefit of this balloon, the ventral part sits just behind the posterior part of the hard palate thereby guaranteeing strong anchoring during ventilation and transportation. Complete inflation of the recommended volume is mandatory in emergency situations. Indications for the combitube are: Ventilation in normal and abnormal airways, airway management in trapped patients, and failed intubation. But why way till the intubation is failed? Why wait till your patient has long-term brain damage because you time with rapid sequence intubation has failed?
The combitube allows successful passage and ventilation in many patients via esophageal route and functions in either the trachea or esophagus. There is a high probability...