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- Cardiac arrest / Resp. arrest (unconscious, no gag reflex, apnea or reps < 6 / minute)

- Appears ≥ 12 years old

- Appears at least 4’ tall (for SA size, up to 6’ tall) or 5’ tall (for regular size)



- Combitube (regular or SA), Right angle emesis deflector

- ETCO2 device (use for pts. with perfusing rhythms)

- 140 ml and 20 mL syringes

- ET holder

- Suction catheter



1.  Ventilate pt. with 100% O2 prior to insertion.

2.  Place head in neutral position.

3.  Grasp lower jaw with thumb and index finger and lift.

4.  Hold Combitube in other hand with curvature in same direction as natural curvature of the pharynx.

5.  Blindly insert tube gently into mouth & advance until front teeth are between the two black rings on the tube.

6.  Do not force the tube.  If the tube doesn’t advance easily, redirect it or withdraw and reinsert.

7.  Inflate cuff #1 with 100 mL of air  (85 mL for SA size).

8.  Inflate cuff #2 with 15 mL of air  (12 mL for SA size).

Start Ventilating Using Tube #1:


- Epigastrium Quiet, Chest Rise, Lung Sounds Present

- If no lung sounds, no rise of chest see **

- If Free Air see **

*This is in an Esophageal Position*

Continue Ventilation Using Tube #1


**If Epigastric sounds, no chest rise, lung sounds absent**

*This is in a Tracheal Position*

Ventilate Using Tube #2


Continue Monitoring:


- Secure with ET Holder or Tape

- Reassess EDD/ETCO2 and Lung Sounds After pt. Movement

- Documentation



- Unable to auscultate breath sounds when ventilating via tube #1 or #2

- Mechanical failure of tube

- Return of gag reflex

- Patient awakening and/or gagging on tube

- Combative patient



- Consider decompressing stomach if in esophagus, using 12 fr catheter

- Suction mouth

- Turn patient on side

- Deflate cuff #1

- Deflate cuff #2

- Remove Combitube with suction standing by

- Monitor pt’s respiratory status and intervene as necessary

- Provide supplemental O2 or ventilate with BVM as needed

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