Indications
a. Inadequate oxygenation &/or ventilation
b. Need to provide airway protection in an obtunded patient without an active gag reflex
c. Inability or unable to perform endotracheal intubation
Contraindications
a. Patients who are conscious or have an intact gag reflex
b. Patients with known esophageal pathology or ingestion of caustic substances
Insertion technique
a. Maintain patient’s head in a neutral position. Using a jaw-lift, insert the Combitube to the depth indicated by the markings on the tube. The black rings should be situated between the teeth.
b. Inflate the pharyngeal cuff with 100 mL of air.
c. Inflate the distal cuff with 10 – 15 mL of air.
d. Initiate ventilation through the blue connector. Assess lung and gastric sounds.
i. If lung sounds PRESENT: Continue ventilation at 12 – 15 breaths per minute.
ii. If lung sounds ABSENT: Ventilate through shorter, clear connector.
iii. If gastric sounds PRESENT: Add additional air to distal cuff.
e. Continue to ventilate through which connector gives good lung sounds.
f. Continuously reassess lung sounds for correct placement.