King airway

[PCP]

Here in BC. Canada we as Primary Care Paramedic or EMT-I ( I think?) are going to be taking a training course in the use of the King Airway. As of right now, we are only able to use the OPA for securing someones airway.

My question is what are the pros and cons about using the King airway?

How difficult is it to isert into the trachea?

How much time should be spent attempting to place the advanced airway, before just resorting back to using the OPA? (Remeber I do not have ALS available in my community.)

Thank you all for your answers and comments

Brian

[HellsBells]

First of all, its important to know that this device does not fit into the trachea, it is inserted into the esophagus.

Personally, I have never used one, actually we just started using them about two weeks ago. However during training they seemed easy to use and should take a few seconds to insert. I think you will find they work much better than an OPA/BVM.

[paramedicmike]

This device does not insert into the trachea. It is a blind insertion airway device that is ridiculously easy to use. This is our backup airway device. I've used it on patients who, for a variety of issues, couldn't be intubated and have never had a problem with it doing exactly what it is designed to do.

You asked about timing. If a provider can't place this device on their first attempt (i.e. mere seconds worth of time) then there are some larger issues at play.

It really is that easy. Easier than a Combitube, even.

Edited December 15, 2010 by paramedicmike

[PCP]

WOW!! Okay, thank you for the information. Sounds like it will be easier to use than I was expecting and by the sounds of it, If I can not ensert the airway, than I best go back to school..LOL..

Silly question time...So if this mechanism is inserted into the Esophagus would that not cause gastricdistention? Or is that reason for pumping up the balloon so that it blocks the air from going into the esophagus and redirects the air down into the trachea?

[paramedicmike]

When you "inflate the balloon" there will be two inflations on the tube. The distal inflation secures the esophagus. The proximal fills the oropharynx above the glottic opening. The openings for ventilation purposes are between the two balloons so air/oxygen can be directed into the right spot.

If, however, you use the wrong size or don't inflate the cuffs enough then there is a risk for gastric distention. Proper use of this device, though, should not result in a distention related problem.

I think once you get your hands on the tube itself you'll get a better idea of how it works. If you google "King LT airway" and look at the images that come up you should get a better idea of how it sits and how the inflations work with patient anatomy.

What else would you like to know? These things really are a good tool to have available. Just a word of caution. Once you put these into service make sure there are educational opportunities at your local receiving hospital(s) to make sure the docs know what they could be getting. The last thing you want is for some doc who has never seen one ripping it out with the cuffs still inflated.

[mobey]

WOW!! Okay, thank you for the information. Sounds like it will be easier to use than I was expecting and by the sounds of it, If I can not ensert the airway, than I best go back to school..LOL..

Silly question time...So if this mechanism is inserted into the Esophagus would that not cause gastricdistention? Or is that reason for pumping up the balloon so that it blocks the air from going into the esophagus and redirects the air down into the trachea?

When you get your training you will see how it is constructed. Aside from that, a Google search should answer your questions better than my trying to type out a description.

If you can insert an OPA, you can insert a King IMO. They go in pretty well the same way.. just deeper. One cuff to inflate with a color coded syringe, and presto.

I myself have used 7 now. I got so I was no longer using OPA's during codes. They are quick to put in, and even Paramedic proof.

[PCP]

When you "inflate the balloon" there will be two inflations on the tube. The distal inflation secures the esophagus. The proximal fills the oropharynx above the glottic opening. The openings for ventilation purposes are between the two balloons so air/oxygen can be directed into the right spot. If, however, you use the wrong size or don't inflate the cuffs enough then there is a risk for gastric distention. Proper use of this device, though, should not result in a distention related problem. I think once you get your hands on the tube itself you'll get a better idea of how it works. If you google "King LT airway" and look at the images that come up you should get a better idea of how it sits and how the inflations work with patient anatomy. What else would you like to know? These things really are a good tool to have available. Just a word of caution. Once you put these into service make sure there are educational opportunities at your local receiving hospital(s) to make sure the docs know what they could be getting. The last thing you want is for some doc who has never seen one ripping it out with the cuffs still inflated.

Thanks paamedicmike. As for us paramedics we are taking a training course starting early January. As for the ER Docs I am not sure what there training will be or introduction to this will be. I just assumed that they would know what we are using. Great point to make as to make sure the Docs know what we are using. I googled "King LT airway" and from the information I read and the pictures it looks and sounds pretty basic as long as I use the correct size as Mobey mentioned. <BR>Once we have inserted the airway is there a strap that we use to secure the airway in place so that it does not move around while ventilating a patient?<BR>And is there a chance of the tube ever coming out once the balloons have been enflated? Edited December 15, 2010 by PCP

[paramedicmike]

Tape works to secure the device. It will also fit in a Thomas Tube Holder. If they don't bring this up in your training I would make sure to ask.

[firemedic37]

The King Airway is my favorite primary and back-up airway. Most of the time when I am working I am the only medic on so time is very important to me. You can prep and insert this airway in less that 30 seconds when you get it down and feel comfortable with it. I usually use it as a primary airway on all cardiac arrest or when I am in very tight spaces and don't have the room to intubate.

If you use the one with the suction port you can intubate through it with the use of a elastic gum bougie if you have the training and protocol for it. So it is very easy and quick to upgrade from a King Airway to a ET Tube.

I use the King Airway and easy IO on all cardiac arrest because EMT-B's in my state are allowed to use the King Airways and I can do an IO a lot faster than an IV. This allows me to focus more on good chest compressions and ACLS.

[chbare]

The King Airway is my favorite primary and back-up airway. Most of the time when I am working I am the only medic on so time is very important to me. You can prep and insert this airway in less that 30 seconds when you get it down and feel comfortable with it. I usually use it as a primary airway on all cardiac arrest or when I am in very tight spaces and don't have the room to intubate.

If you use the one with the suction port you can intubate through it with the use of a elastic gum bougie if you have the training and protocol for it. So it is very easy and quick to upgrade from a King Airway to a ET Tube.

I use the King Airway and easy IO on all cardiac arrest because EMT-B's in my state are allowed to use the King Airways and I can do an IO a lot faster than an IV. This allows me to focus more on good chest compressions and ACLS.

Why exchange a functional airway for the uncertainty that comes with placing another airway that may or may not work? I'm not all that keen on exchanging rescue devices in the field. Sometimes, the enemy of good is better IMHO,

Take care,

chbare.