Standards Procedure (Skill)
Clinical Indications: Levels: EMT-B, EMT- D,
EMT-I, EMT-P
Ø In an apneic patient when endotracheal inubation is not possible or not available.
Ø Patient must be > 5 feet and > 16 years of age.
Ø Patient must be unconscious.
Procedure:
a. Preoxygenate and hyperventilate the patient.
b. Prepare and lubricate the tube. Check both balloons.
c. Grasps the patient’s tongue and jaw with your gloved hand and pull forward.
d. Gently insert the tube until the teeth or gums are between the printed rings.
e. Inflate cuff #1 (blue pilot balloon) with 100cc of air.
f. Inflate cuff #2 (white pilot balloon) with 15cc of air.
g. Ventilate taller blue tube (#1) with bag valve mask.
h. Auscultate for breath sounds and sounds over the epigastrium.
i. Look for rise and fall of chest.
j. If breath sounds are positive and epigastric sounds are negative, continue to ventilate through the blue tube. The tube is in the esophagus.
k. Such case above allows you to aspirate stomach contents through the #2 white tube to relieve some gastric distention.
l. If breath sounds are negative and epigastric sounds are positive, attempt to ventilate through the shorter white (#2) tube and assess for breath sounds and epigastric sounds. If breath sounds are present and epigastric sounds are absent, continue to ventilate through the white tube (#2), you have intubated the trachea.
m. The device is secured in place by the large pharyngeal balloon.
n. Confirm tube placement by using an end-tidal CO2 detector or esophageal bulb device.
Endotracheal intubation with a combi-tube in place:
a. The tube must be in the esophageal mode.
b. Prepare all equipment needed for endotracheal intubation.
c. Decompress the stomach by aspirating through the shorter, white tube (#2).
d. Hyperoxygenate the patient.
e. Deflate the bulbs on the Combi-tube and remove Combi-tube. Suction equipment should be ready.
f. Rapidly proceed with endotracheal inubation.
Certification Requirements:
Successfully complete an annual skill evaluation including the indications, contraindications, technique, and possible complications of the procedure.