22.7b Retroglottic Airway Devices - Esophageal Tracheal Combitube

Dual-lumen devices

(?) are designed to be inserted blindly into the esophagus but can still be used in the event of fortuitous tracheal placement.

Clinical assessment

(?) is required to be sure that the correct port is used for ventilation.

Esophageal Tracheal Combitube® (ETC) and the Pharyngeal Tracheal Lumen (PTL) Airway

EGAs in this category include the (?) .

King LT™

These airways were commonly used in the past but have been replaced in many systems with the (?) or laryngeal mask-type airways.

Esophageal Tracheal Combitube (ETC™)

The ?, also called simply the Combitube™, is a dual-lumen retroglottic airway available in two sizes for patients over 4 feet tall.

inserted blindly

It is (?) through the mouth into the posterior oropharynx and then gently advanced—although directed esophageal placement using a laryngoscope is often employed in the operating room (OR) and can be employed by EMS practitioners if it is within their scope of practice.

trachea or esophagus

The tube can enter either the (?), but esophageal placement is most common.

#1

Because placement is nearly always esophageal, the port that ventilates in this position numbered (?) is longer, and is blue.

rapid

Incorporation is (?) and highly successful.

visualization

Insertion does not require (?).

ventilation

It provides (?) with either esophageal or tracheal placement.

pharyngeal balloon

The large (?) can tamponade oral bleeding.

high airway pressures

It generates (?) for ventilation when necessary.

aspiration protection

It offers reasonable (?) in either the esophageal or tracheal position.

gastric decompression

In the esophageal position, (?) is possible through the #2 port.

proximal balloon, distal balloon

When intubating around the ETC, the (?) can be deflated and the (?) left inflated to seal off the esophagus.

esophageal perforation

Trauma, including (?) , has been reported.

intact gag reflex

It cannot be placed in patients with an (?).

High cuff volumes

(?) can result in tissue ischemia.

4 feet tall

It cannot be placed in patients under (?).

correct port

Clinical assessment is necessary to ensure ventilation through the (?).

esophageal position

It does not completely isolate the trachea in the (?).

100 percent foolproof

Placement is not (?).

Regular size

Select a (?) for patients 6 feet tall or taller.

Small-Adult size

Select a (?) for patients less than 6 feet tall.

manufacturer’s instructions

Note that this sizing instruction is evidence based but is different from the (?) .

bilateral breath sounds

If you hear (?) over the chest and none over the stomach (indicating that the device is sitting in and occluding the esophagus while directing oxygen flow into the trachea), secure the tube and continue ventilating.

End-tidal CO2

(?) is reliable with an ETC as long as the patient is producing CO2.

esophageal detector device (EDD)

An (?) can be used on an ETC by attaching it to the #2 port that is open on the distal end.

failure to inflate

Note that (?) indicates appropriate esophageal positioning and you should continue ventilation through the #1 port.

backward

This is somewhat (?) compared with using an EDD to confirm endotracheal intubation.

reassess

Frequently (?) the airway and adequacy of ventilation.