NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5316

POLICIES AND PROCEDURES

Subject: Medical Direction

Esophageal Obturator Airway ( EOA )

Esophageal Gastric Tube Airway ( EGTA )

Associated Policies: 01/13/98

  1. Indications:
  1. Immediate endotracheal or nasal tracheal intubation cannot be performed.
  2. Attempts at endotracheal intubation have proved unsuccessful.
  3. Direct visualization of the larynx is inhibited because of bleeding or emesis.
  1. Therapeutic Effects:
  1. Rapid insertion and larynx does not have to be visualized.
  2. Prevents gastric distention and regurgitation.
  3. Delivers ventilations at the level of the hypopharynx.
  1. Contraindications:
  1. Absolute:
  1. Conscious or semiconscious patients with a gag reflex.
  2. Persons under 5 feet tall.
  3. Extremely tall adults (over 6’ 6").
  4. Patients with known history of esophageal diseases.
  5. Cases of caustic ingestion.
  1. Equipment:
  1. EOA or EGTA tube and mask.
  2. 20 cc or 30 cc syringe.
  3. Stethoscope
  4. Bag Valve Mask Device with oxgyen enrichment device.
  1. Procedure:
  1. Insertion Procedure:
  1. Place patient supine with head in neutral position.
  2. Check equipment.
  3. Hyperventilate at rate of 20 to 24 times a minute.
  4. A tongue-jaw-lift should be used with one hand while device is inserted with other hand.
  5. Introduce EOA/ ETGA with face mask attached into posterior pharynx.
  6. Advance EOA/ EGTA until face mask rests on face. If resistance is met, withdrawal device slightly, improve the jaw-lift, and re-advance.
  7. Deliver ventilation and observe for chest rise/ ascultate breath sounds. If no chest rise or breath sounds are detected. IMMEDIATELY remove the EOA/ EGTA and ventilate by other means.
  8. Inflate cuff, amount of air used should be considered patient-dependent, 30-35 cc maximum.
  9. Observe for chest rise / ascultate breath sounds.
  10. Hyperventilate patient with 100% oxygen via BVM at rate of 20 to 24 times a minute.
  11. Gastric decompression with an EGTA can be performed with placement of NG tube into gastric tube. Maintain low suction levels.
  1. Removal Procedure:
  1. If patient is unconscious, an ET tube should be placed prior to EOA/ EGTA removal. Deflate EOA/ EGTA cuff. Remove EOA/ EGTA. Have suction available.
  2. If patient’s condition has improved (gag reflex and spontaneous respiration present) EOA/ EGTA should be removed. The patient should be rolled onto his side and suction made ready. Deflate EOA/ EGTA cuff. Remove EOA/ EGTA.
  1. Special Information:
  1. Use with caution with suspected drug overdose.
  2. Airway will not protect the aspiration of foreign material that is present in the mouth or pharynx.