Airway Management in the Combat Casualty

Overview Discuss why we would secure an airway in the firefight casualty Discuss and analyze some options in establishing an airway in the combat casualty Review the use of the Combitub

Secure the Airway What questions need to be answered when we plan for airway management? –What is effective? –What is easy and quick to use? Consider yourself inexperienced –What requires minimal equipment? –What is my back-up? The Nasopharyngeal Airway, Combitube are excellent choices!

Options Endotracheal intubation in the hands of an inexperienced provider, with a controlled setting has about a 42% success rate. The Combitube has a 95% success rate in the field.

Nasopharyngeal Airway (NPA) 1% of all firefight fatalities can be salvaged by ensuring the airway is patent throughout evacuation. All unconscious/altered mental status casualties should have their airway secured with a NPA.

Elbow deflector Suction catheter Small syringe: 20 ml distal cuff Large (blue) syringe: 100 ml large balloon Ringmarks Distal cuff Oropha- ryngeal ballon

„Pharyngeal“ lumen No. 1 „Esophago- tracheal“ lumen No. 2 Esophageal - tracheal COMBITUBE Oropharyngeal balloon Distal cuff Perforations

Specially useful: Difficult intubation Blind intubation Difficult circumstances (space, illumination) Combitube

Emergency intubation Bleeding and vomiting Immediate decompression of esophagus and stomach The casualty must be unconscious and have no gag reflex Note: The casualty must be unconscious and have no gag reflex Indications for Combitube

Merits of COMBITUBE Low price, all-in-one device Non invasive No preparations necessary Rapid and easy intubation Immediate fixation PREVENTION OF ASPIRATION

Complications Aspiration –Ensure there is no gag reflex Esophageal perforation Direct trauma to the larynx

The Basic Procedure Open mouth, press away tongue Head: Neutral position

The Basic Procedure Flat insertion along tongue

The Basic Procedure Emergency: No. 2: 10 ml Emergency: No. 1: 85 ml (or more)

The Basic Procedure Esophageal position Self- fixation Behind hard palate Active decom- pression Ventilation via longer blue tube No. 1

The Basic Procedure Ventilation via shorter clear tube No. 2 Tracheal position

Questions??