EMT Basic
Advanced Airway
Management
Pharyngeal Esophageal Airway Device
(PEAD)
A.K.A. Combitube©
PowerPoint developed by Jennifer Stanislaw, EMT-P, EMS Training Officer
West Valley Fire District, Willamina, OR
The Cat Fan (No Pun Intended)
Agenda
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Review Objectives
Lesson 1
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Lesson 2
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Respiratory Anatomy & Physiology
Respiratory Volume and Management
Lesson 3
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Assessing Respiratory Problems
Agenda cont’d
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Lesson 4
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Lesson 5
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Respiratory/Cardiac Arrest
Basic Airway Management
Suctioning
Lesson 6
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Dual-Lumen Airway Devices
Agenda cont’d
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Demonstration
Practical Stations
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Basic Airway Management
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Manual Maneuvers and Simple Adjuncts
Supplemental Oxygen
Ventilation
Suctioning
Combitube Insertion
Practical
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Testing must be done with the Physician
Advisor (or another Physician of his / her
choosing)
Objectives
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Describe the anatomy and function of the upper
and lower airways
Describe respiratory volumes and capacities in
relationship to the need for assisted ventilations
Identify the specific observations and physical
findings commonly found in patients presenting
in respiratory and/or cardiac arrest.
Identify the basic principles of airway
management
Objectives (cont’d)
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Describe the indications for suctioning.
Identify rigid and flexible suction catheters
and the indications for use.
Identify indications and contraindications
for use of the PEAD’s.
Identify the advantages and disadvantages
of using PEAD’s.
Objectives (cont’d)
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Identify those situations in which PEAD’s
may be removed.
Demonstrated placement of PEAD’s.
Demonstrate methods of assuring and
maintaining correct placement of PEAD’s.
Demonstrate re-ventilation for missed
placement of PEAD’s.
Objectives (cont’d)
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Demonstrate on a manikin the proper
technique for the use and maintenance of
the following airway adjuncts:
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Nasal cannula
Non-rebreather mask
Bag-Valve-Mask
Demonstrate sterile suctioning techniques
on a manikin with a PEAD in place.
Lesson 1
Respiratory Anatomy & Physiology
Respiratory Anatomy & Physiology
Function of the Respiratory System
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Removes carbon
dioxide from the blood
Transfers oxygen to
the blood
The Upper Airway
A
B
C
D
E
F
G
H
Epiglottis
Mandible
Frontal Sinus
Soft Palate
Trachea
Glottis
Esophagus
Vocal Cords
The Upper Airway
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Other Structures
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Nasopharynx
Oropharynx
Hypopharynx
Larynx
Functions
Functions of the Upper Airway
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Passageway for air
Warm
Filter
Humidify
Protection
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Gag Reflex
Cough
Speech
The Lower Airway
A Primary
Bronchi
B Hyoid Bone
C Right Lung
D Secondary Bronchi
E Tracheal Ligament
F Trachea
G Larynx
H Esophagus
I Left Lung
J Trachea
Alveoli
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Gas Exchange
Lungs
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Structure
Lobes
Pleura
Physiology of Respiration
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Define Respiration
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The exchange of gases between a living
organism and the environment
Define Ventilation
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Mechanical Process that moves air in and out of
the lungs
Muscles of Breathing
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Intercostal Muscles
Diaphragm
Regulation of Respiration
Where is the Respiratory Center Controlled?
 Brainstem
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Stretch receptors
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Medulla
Apeustic Center (pons)
Pneumotaxic center (pons)
Hering-Breuer reflex
Chemoreceptors
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CSF
Blood
Voluntary or Involuntary
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Both
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Humans can override body’s urge to breathe
But only for so long
Respiratory Cycle
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Inspiration
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Active phase
Lasts 1-2 seconds
Expiration
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Passive phase
Lasts 5 seconds
Lesson 2
Respiratory Volume and
Management
Drinking Straw Exercise
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Breathe through
straws for 1 minute
Carbon Dioxide & The Respiratory
System
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High CO2
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Low CO2
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Increases respiratory rate
Decreases respiratory rate
Hypoxic Drive
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Chronic COPD patients
Normal Respiratory Rates
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Adult
Children
Infants
Newborns
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12 – 20 / min
18 – 24 / min
22 – 36 / min
40 – 60 / min
Factors Affecting Respiratory Rate
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Fever
Depressant Drugs
Anxiety
Insufficient Oxygen
Stimulant Drugs
Sleep
Respiratory Volumes
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Lung Capacity
Tidal Volume
Dead Space
Alveolar Air
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6000 mL of air
500 mL at rest
150 mL
350 mL
Minute Volume
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Total air moved per minute
Rate X Volume = Minute volume
Important Assessment Item
Factors Affecting Minute Volume
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Head, neck, chest injury
Shock
Diabetes
CO2 / O2 rapid changes
Maintaining the A in ABC
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Patient positioning
Suctioning
Supplemental Oxygen
Mechanical Assistance
Pulse Oximetry
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Measures amount of oxygen in the blood.
Gives percent of hemoglobin saturated
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Tool only, do not rely on totally
Why?
Normal Values
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95% - 100% Normal
90% - 95% - Mild – Normal for COPD
< 90 % Moderate – High Flow Oxygen
End-Tidal CO2 Detection
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Measured
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Colorimetric and Digital
Tool to aid in determining correct placement
Lesson 3
Assessing Respiratory Problems
Patient Assessment
General Patient Assessment
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Primary Survey
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LOC
ABC’s
Speech Pattern
Obvious Respiratory Noise
Patient Position
General Assessment (cont’d)
Secondary Assessment
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SAMPLE history
Chief Complaint
Pertinent Negatives
Chest Pain (pleuritic vs cardiac)
Cough History
Edema
Vitals
Respiratory Assessment
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Confusion, Agitation, Orientation
Cyanosis (late sign)
Diaphoresis
Retractions
Accessory Muscle Use
Jugular Venous Distention
Nasal Flaring / Pursed Lip Breathing
Palpation
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Skin
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Turgor
Color
Temperature
Diaphoresis
Pulse
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Rate
Rhythm
Quality
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Chest Wall Pain
Tracheal Deviation
Assessing Lung Sounds
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Methods
Hand Out
Lung Sounds
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Normal
Wheezes
Rales (Crackles)
Stridor
Rhonchi
Pleural Rub
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Listen on every patient
End of Expiration
End of Inspiration
During both phases
Expiration
End of Inspiration
Respiratory Diseases
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COPD
Asthma
Pneumonia
Pulmonary Edema
Pulmonary Embolus
Trauma
COPD
Chronic Obstructive Pulmonary
Disease
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Pink Puffers and Blue Bloaters
Frequently on Home oxygen
Assessment
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Typical Lung Sounds
Common Medications
May or May not be Hypoxic Drive
Asthma
Asthma
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Bronchiole Constriction & Mucous
Production
Lung Sounds
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Wheezes
Diminished
None
Usually Diagnosed
Pneumonia
Pneumonia
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Fever
Productive Cough
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Colored Sputum
General Illness
Elderly & Pediatric most at risk
Lung Sounds
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Rhonchi, Rales, Wheezes
Pulmonary Edema
Pulmonary Edema
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Congestive Heart Failure
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Acute – Flash Pulmonary Edema
Chronic – Heart Failure
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Medications
Orthopnea, PND
Lung Sounds
Keep them upright with legs dangling
Pulmonary Embolus
Pulmonary Embolus
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Lung Sounds
History
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Surgery
Bed Confined
Long trip
Rapid Transport & High Flow Oxygen
Trauma
Trauma
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Maintain spinal control
Airway Management
High Flow Oxygen
Rapid Transport
Seal Chest Wounds
Stabilize Impaled Objects
Lesson 4
Respiratory/Cardiac Arrest
Basic Airway Management
Respiratory & Cardiac Arrest
Assessing the Patient
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First Steps of CPR
Annie, Annie You Okay?
Other Signs and Symptoms
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Unconsciousness
Cardiac Seizure
Agonal respirations or apnea
Cyanosis, Ashen, Mottled
No signs of spontaneous respiration or circulation
No Pulse
Combitube
When to Use the Combitube
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CPR
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Remember to do CPR!
Attach AED!
Respiratory Arrest
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Agonal Respirations without intact gag reflex
Respiratory Arrest leads to Cardiac Arrest
Airway Management – The Basics
Manual Maneuvers
 Chin Lift
 Jaw Lift
 Jaw Thrust
 Head Tilt – Chin Lift
 Modified Jaw thrust
Airway Management – The Basics
Mechanical Airways
 NPA’s
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OPA’s
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Description
Advantages
Disadvantages
Indications
Contraindications
Methods of Insertion
Airway Management – The Basics
Ventilation
 Mouth to Mask
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BVM
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Description
Advantages
Disadvantages
Indications
Contraindications
Methods of Use
Evaluation of Effectiveness
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How do I know I am ventilating?
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Chest movement
Lung Sounds
Epigastric sounds/Abdominal distention
Patient Response
Lesson 5
Suctioning
Reviewing Suctioning
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BSI – Scene Safety
Equipment
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Suction device
Rigid or Soft Tip
Insert with Suction Off
Withdraw while
Suctioning
No more than 15
seconds before
ventilating!
Oh, That Sucks!
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Vomitus
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Food
Protein dissolving
enzymes
Hydrochloric Acid
Aspiration damage
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Alveolar Damage
Increased fluid
Obstruction
Aspiration Pneumonia
Oh, Go Spit on It
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Saliva
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Digestive enzymes
Bacteria
Aspiration Damage
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Fills alveoli
Pneumonia
Food
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Clogs airways
Interferes with
ventilation
Pneumonia
Blood
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Contents
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Protein
Fibrin
Water
Electrolytes
Aspiration Damage
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Clog small airways
Creates chemical
reaction
Suction Catheters
Rigid
 Advantages
 Disadvantages
 Indications
 Contraindications
 Methods of Use
Flexible
 Advantages
 Disadvantages
 Indications
 Contraindications
 Methods of Use
Lesson 6
Dual-Lumen Airway Devices
Combitube©
Description
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Other Similar Devices
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Pharyngeal tracheal lumen airway (PTLA)
EGTA
EOA
What we use
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Combitube©
Indications for Combitube©
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Respiratory Arrest
Cardiac Arrest
Unconscious, without a gag reflex
Contraindications for Combitube©
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Gag Reflex
Conscious
Breathing Adequately
Caustic Ingestion
Known esophageal disease or varices
Under 16 y/o
Under 5 feet or over 6 feet 8inches
Advantages for Combitube©
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Rapid Insertion
Limits regurgitation, aspiration & distention
Blind insertion
High oxygen delivery
Less training required
Inserted in neutral position
Disadvantages for Combitube©
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Patient must be unresponsive without gag
reflex
Some are difficult to obtain adequate seal
Some do not totally protect against
aspiration
Most responsive patients will vomit when
removed
May damage esophagus
Demonstration
When Can I Remove the Combitube?
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Patient returns to full consciousness
Patient able to maintain own airway
Orders from OLMC
Procedure for Removing
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SUCTION READY!
Deflate Tube #2
Deflate Tube #1
Tell patient to exhale
Pull out quickly and in-line
SUCTION
Demonstration
Skills Labs
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Basic Airway Management
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Manual Maneuvers and Simple Adjuncts
Supplemental Oxygen
Ventilation
Suctioning
Advanced Airway Management

Combitube
Questions?