Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 If the CombiTube is in the esophagus, as it usually is, you would be putting drugs into the stomach where they are poorly absorbed, attacked by stomach acid, and so forth. No recommendation for such exists. If by chance it went into the trachea, in which you'd have been ventilating through the white or clear tube, then you could put drugs down it, since at that time it's functioning just as an ET tube would. There's no evidence that medications put down the tube work. Your medical director is an idiot and a fool for not allowing IO. Kick him out and get one that lives in this century. Gene G. > > > Scenerio: > > Pt is found pulseless you put pads on and find vfib and shock you now have > asystole an intubation is attempted with no success so a combi-tube is put > in place. Only one EMS person in the back of the truck and no-one is > available to come help (you are in rural area Texas) No one to drive the > truck while your partner gets in the back. It is pouring down rain so no > air ambulance available. The patient has no veins and I/O is not capable > because your medical director want allow it. Is a possibility to put drugs > down the combi-tube like you can down the ET tube. If you are grasping at > straws can you double or triple what you would give IV or do you just do > CPR. Is there something wrote somewhere that this is a definite NO or is > there a maybe putting drugs down the combi-tube better than doing nothing? > Just curious. > > Debbie > > > ************** Get fantasy football with free live scoring. Sign up for FanHouse Fantasy Football today. (http://www.fanhouse.com/fantasyaffair?ncid=aolspr00050000000020) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 Because the distal cuff, which is now in the trachea, would block off the drugs from going beyond that point. They would just back up into the hypopharynx. There would be very little absorption through the tissues there, if at all. GG > > But why wouldn't be misted in to the lungs through the holes in the blue > tube? > > Re: Combi-tube Question > > <snipped> > > >>Is a possibility to put drugs down the combi-tube like you can down > the ET tube.<< > > No, and yes. > > If you are successfully ventilating through Lumen #1 of the Combitube > (blue), the device is placed esophageally. If memory serves, this is the > placement about 80% of the time. Meds instilled down Lumen #1 would go > nowhere, since it has a blind end. If you instill meds down Lumen #2 in > that situation, you're essentially giving code drugs down the esophagus. > It would have about the same effect as trying to give oral medications > to a dead person, which is to say, none at all. > > If, on the other hand, you are successfully ventilating through Lumen #2 > (clear or white lumen), the device is placed tracheally and that lumen > functions just like an ET tube. In *that* situation only, meds given > down the Combitube might be equivalent to endotracheal medication > administration. > > Which leads me to my next point, which is that ET meds in the arrest > patient are just about worthless. There isn't enough pulmonary > circulation with CPR to get a reliable absorption of ET instilled meds, > plus if you give them like I see most medics do (two Bristojects of Epi, > Atropine, or Lidocaine straight down the tube), the correct terminology > is not " medicating. > > It's " drowning. " > > -- > Grayson, CCEMT-P > www.kellygrayson. ww > > ------------ -------- -------- ----- > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 You would be better injecting the drugs directly into the tongue through the bottom of the jaw. The tongue has lots of vasculature, but in a code, circulation is very low flow. I doubt there would be any effect, just as says. Eventually I suspect we'll be down to maybe one drug in cardiac arrest, and that might be vasopressin. GG > > >>But why wouldn't be misted in to the lungs through the holes in the > blue tube?<< > > It could be, theoretically. ET medications are one of those things we've > been taught for years, but has never been actually proven to work. > > Then again, you have oral mucosa, tongue, vocal cords, etc all absorbing > some of the medication before it even reaches the alveolar capillary beds. > > And that's presuming it actually works when it gets there, Debbie. The > evidence shows that it doesn't. I can't cite the original study, but I > recall one in particular where ICU patients who arrested were given IV > epinephrine at 1mg, endotracheal epinephrine at 2mg instilled via a > catheter down the ET tube (presumably the *most* effective ET delivery > method), or no epinephrine at all. > > These patients had arterial lines and pulmonary artery catheters, and > the researchers could detect no significant difference in hemodynamics > between endotracheal epinephrine and no epinephrine at all. > > If any of you research gurus have an studies you can cite on the > efficacy of endotracheal medications, please chime in...if any exists. > > -- > Grayson, CCEMT-P > www.kellygrayson. ww > > > ************** Get fantasy football with free live scoring. Sign up for FanHouse Fantasy Football today. (http://www.fanhouse.com/fantasyaffair?ncid=aolspr00050000000020) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 Scenerio: Pt is found pulseless you put pads on and find vfib and shock you now have asystole an intubation is attempted with no success so a combi-tube is put in place. Only one EMS person in the back of the truck and no-one is available to come help (you are in rural area Texas) No one to drive the truck while your partner gets in the back. It is pouring down rain so no air ambulance available. The patient has no veins and I/O is not capable because your medical director want allow it. Is a possibility to put drugs down the combi-tube like you can down the ET tube. If you are grasping at straws can you double or triple what you would give IV or do you just do CPR. Is there something wrote somewhere that this is a definite NO or is there a maybe putting drugs down the combi-tube better than doing nothing? Just curious. Debbie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 <snipped> >>Is a possibility to put drugs down the combi-tube like you can down the ET tube.<< No, and yes. If you are successfully ventilating through Lumen #1 of the Combitube (blue), the device is placed esophageally. If memory serves, this is the placement about 80% of the time. Meds instilled down Lumen #1 would go nowhere, since it has a blind end. If you instill meds down Lumen #2 in that situation, you're essentially giving code drugs down the esophagus. It would have about the same effect as trying to give oral medications to a dead person, which is to say, none at all. If, on the other hand, you are successfully ventilating through Lumen #2 (clear or white lumen), the device is placed tracheally and that lumen functions just like an ET tube. In *that* situation only, meds given down the Combitube might be equivalent to endotracheal medication administration. Which leads me to my next point, which is that ET meds in the arrest patient are just about worthless. There isn't enough pulmonary circulation with CPR to get a reliable absorption of ET instilled meds, plus if you give them like I see most medics do (two Bristojects of Epi, Atropine, or Lidocaine straight down the tube), the correct terminology is not " medicating. " It's " drowning. " -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 But why wouldn't be misted in to the lungs through the holes in the blue tube? Re: Combi-tube Question <snipped> >>Is a possibility to put drugs down the combi-tube like you can down the ET tube.<< No, and yes. If you are successfully ventilating through Lumen #1 of the Combitube (blue), the device is placed esophageally. If memory serves, this is the placement about 80% of the time. Meds instilled down Lumen #1 would go nowhere, since it has a blind end. If you instill meds down Lumen #2 in that situation, you're essentially giving code drugs down the esophagus. It would have about the same effect as trying to give oral medications to a dead person, which is to say, none at all. If, on the other hand, you are successfully ventilating through Lumen #2 (clear or white lumen), the device is placed tracheally and that lumen functions just like an ET tube. In *that* situation only, meds given down the Combitube might be equivalent to endotracheal medication administration. Which leads me to my next point, which is that ET meds in the arrest patient are just about worthless. There isn't enough pulmonary circulation with CPR to get a reliable absorption of ET instilled meds, plus if you give them like I see most medics do (two Bristojects of Epi, Atropine, or Lidocaine straight down the tube), the correct terminology is not " medicating. " It's " drowning. " -- Grayson, CCEMT-P www.kellygrayson.com ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 30, 2008 Report Share Posted July 30, 2008 >>But why wouldn't be misted in to the lungs through the holes in the blue tube?<< It could be, theoretically. ET medications are one of those things we've been taught for years, but has never been actually proven to work. Then again, you have oral mucosa, tongue, vocal cords, etc all absorbing some of the medication before it even reaches the alveolar capillary beds. And that's presuming it actually works when it gets there, Debbie. The evidence shows that it doesn't. I can't cite the original study, but I recall one in particular where ICU patients who arrested were given IV epinephrine at 1mg, endotracheal epinephrine at 2mg instilled via a catheter down the ET tube (presumably the *most* effective ET delivery method), or no epinephrine at all. These patients had arterial lines and pulmonary artery catheters, and the researchers could detect no significant difference in hemodynamics between endotracheal epinephrine and no epinephrine at all. If any of you research gurus have an studies you can cite on the efficacy of endotracheal medications, please chime in...if any exists. -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 from Gene " Your medical director is an idiot and a fool for not allowing IO. Kick him out and get one that lives in this century. " Don't hold back now tell us how you feel. LOL I do agree though IO is such an easy access to get why would it not be permitted....wake up we are in 2008 and everyone else has been doing IO's for several years Terrell For what its worth Terrell EMT-P CC...,...,...,.,....( all the other things that still mean I am a paramedic) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 31, 2008 Report Share Posted July 31, 2008 A canine study* examined the role that the Combitube may play in drug administration when IV access is not available. Unfortunately, therapeutic levels of lidocaine were never reached demonstrating that the Combitube is not an effective route for medication administration (at least in the canine model.) The FDA also has never approved this device as an acceptable route for medication administration. *Hamilton RS, DP, Nordt SP, Vilke GM, Chan TC. Lidocaine administration through an esophageally placed combitube in a canine model. Acad Emerg Med 6:519-b. Rick LaChance, BA, EMT-P Department of Emergency Medicine Education UT Southwestern Medical Center Dallas, TX 75390-8890 >>> On Wed, Jul 30, 2008 at 4:20 PM, in message , Grayson wrote: <snipped> >>Is a possibility to put drugs down the combi-tube like you can down the ET tube.<< No, and yes. If you are successfully ventilating through Lumen #1 of the Combitube (blue), the device is placed esophageally. If memory serves, this is the placement about 80% of the time. Meds instilled down Lumen #1 would go nowhere, since it has a blind end. If you instill meds down Lumen #2 in that situation, you're essentially giving code drugs down the esophagus. It would have about the same effect as trying to give oral medications to a dead person, which is to say, none at all. If, on the other hand, you are successfully ventilating through Lumen #2 (clear or white lumen), the device is placed tracheally and that lumen functions just like an ET tube. In *that* situation only, meds given down the Combitube might be equivalent to endotracheal medication administration. Which leads me to my next point, which is that ET meds in the arrest patient are just about worthless. There isn't enough pulmonary circulation with CPR to get a reliable absorption of ET instilled meds, plus if you give them like I see most medics do (two Bristojects of Epi, Atropine, or Lidocaine straight down the tube), the correct terminology is not " medicating. " It's " drowning. " -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
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