Equipment we use on Codes

When working on a code, the most important thing to remember is your ABC's. No, not the alphabet, but rather the ABC's of primary care. The "A" stands for Airway. In order to secure the patient's airway, we rely on a variety of devices. The first being a nasopharyngeal airway.

The nasopharyngeal airway is inserted through the nostril. The indications for use of this airway are as follows:

when the mouth cannot be opened.
in the semi-awake patient where it is better tolerated than the oropharyngeal airway.
when teeth are loose or in poor condition.
in facilitating suction.

Oropharyngeal Airway

The oropharyngeal airway is used on those patients that are unconscious and do not have a gag reflex. The airway is made of hard plastic, which prevents the patient from biting through should he regain consciousness

Combitube Syringes

The Combitube is inserted into the mouth and through to the trachea. The double lumen construction ensures air is directed to the lungs instead of the stomach. Two air bladders are inflated to ensure that the tube does not move while rescue breathing is being performed. These syringes are used to fill the bladders with air. When using the Combitube, a Bag Valve Mask is used to facilitate the respirations.

Our Shock-Trauma and Cardiac Techs use the Laryngoscope for intubation. They allow for visualization of the vocal cords when inserting the airway. This reduces the possibility of the airway being fed into the esophagus instead of the larynx.

The "B" is for Breathing. After we establish a secure airway, it is imperative that we begin respirations. When working a code, we can either do manual breathing for the patient, or use a Bag Valve Mask with an airway adjunct such as the Nasopharyngeal or Oropharyngeal Airways or the Combitube.

When we "bag" a patient, it is because the patient cannot breathe for himself or is having insufficient respirations. The Bag Valve Mask forces air into the lungs and artificial respiration is established. The BVM has ports that allow ancillary oxygen to be administered.

As of May 1, 2001, we are starting to carry the Easy-Cap Carbon Dioxide detector in our intubation kits. The Easy Cap allows for visualization of air circulation. The detector changes color in the presence of CO2. It assists in the verification of correct tube placement during endotracheal or nasotracheal intubation.

The "C" is for Circulation. We do not have any device that assists us in chest compressions, such as the Thumper, so we rely on good old fashioned CPR for this. If the patient is in Ventricular Fibrillation, we will use the Defibrillator to attempt to gain a sinus rhythm.