5-5 USE OF A NON-VISUALIZED AIRWAY (COMBITUBE)

Purpose: To provide an adequate airway for patients with respiratory or ventilatory insufficiency. This procedure may be performed by any appropriately trained and certified First Responder or licensed EMT operating under the Brown County EMS Protocols.

Indications:

1. Cardiac arrest from any cause
2. Respiratory arrest with no gag reflex
3. Unconscious patient with inadequate respiration and no gag reflex

Contraindications:

1. Patient has an active gag reflex
2. Patient has known or suspected esophageal disease
3. Patient has history of ingesting a caustic substance
4. Patient has known or suspected foreign body obstruction of the larynx or trachea

Combitube/ King Airway Contraindications:

1. Patient is under 4 feet in height (review manufacturer’s literature for correct size and placement)

Protocol for use of supraglottic airway (iGEL, LMA, Combitube, King airway or similar).

1. Preparation of the patient for insertion of the non-visualized airway:
   1. Maintain ventilation with an oropharyngeal airway and bag-valve-mask
   2. Take appropriate body substance isolation precautions
   3. Determine and select appropriate airway for size of patient
   4. Prepare the non-visualized airway
      1. Determine cuff integrity (if relevant) per manufacturer's directions
      2. Lubricate as necessary
      3. Insure all necessary components and accessories are at hand
2. Prepare the patient
   1. Reconfirm original assessment of need for airway placement
   2. Inspect upper airway for visual obstructions and remove any obstructions found
   3. Pre-oxygenate the patient.
   4. Position the patient's head in a neutral position
3. Airway Insertion
   1. Place and secure appropriately sized supraglottic airway device.
   2. Ventilate the patient
   3. Assess lung sounds for proper airway placement
   4. Continue ongoing respiratory assessment and treatment
4. Tube Removal
   1. Indications
      1. Patient regains consciousness
      2. Protective gag reflex returns
      3. Ventilation is inadequate
      4. Contact MEDICAL CONTROL per protocol, but do not delay removal if indicated and medical control is unable to be contacted.
   2. Remove as per manufacturer’s directions
   3. Monitor airway and respirations closely, suction as needed
   4. Place the patient on high flow oxygen and assist with ventilation as needed
5. Provide Prompt Transportation