King airway

[AlbertaEMT]

I have used the King LT a couple of times. Very easy to insert. The only time there was a problem, was on an aspiration code. The airway was occluded very far down the trachea. As such, not being able to visualize with a laryngoscope made a King LT insertion difficult. Not that I would visualize for a King LT, but having ALS onscene and able to insert an ETT and do deep suction would have been beneficial.

[mobey]

The airway was occluded very far down the trachea. As such, not being able to visualize with a laryngoscope made a King LT insertion difficult.

Can you explain this?

Makes no sense too me.

[firemedic37]

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.

This is a good question, some people may wonder why you would consider upgrading an advanced airway that is already functional. Here are the main reasons; the king airway does not provide a "true" airway, it does not go into the trachea which does not allow you to monitor true end-tidal CO2 the reading is not correct, second you can not put a ventilator on a king airway for the same reason as above and third the king airway is a temporary airway not meant for more than two or three hours at the longest from what I have read.

This does not have to be done in the field but can be very useful. I work for a hospital based ambulance service as well as a private 911 ambulance so I do understand and see both sides. I usually wait until I am at the hospital to exchange for an ET tube so that they can put them on a ventilator. I also don't exchange if it is a code and the patient does not have a perfusing rhythm.

[Richard B the EMT]

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.

I have handled both the Combitube and the King in the classroom, but as of this time, FDNY EMS has not started any Pilot Programs for us EMT-B (BLS) personnel to use them, as far as I am aware. They've not set out the mannequins for us to try practicing, at least.

From what I have seen, and as I understand the instructors, however, usage seems similar.

[Vorenus]

This is a good question, some people may wonder why you would consider upgrading an advanced airway that is already functional. Here are the main reasons; the king airway does not provide a "true" airway, it does not go into the trachea which does not allow you to monitor true end-tidal CO2 the reading is not correct, second you can not put a ventilator on a king airway for the same reason as above and third the king airway is a temporary airway not meant for more than two or three hours at the longest from what I have read.

Yeah, the LT is not a "true airway", as it does not go endotracheal (and therefore, you don`t have the same safety against aspiration that you have with an ET) .

But - that there are problems measuring the etCO2 would be new to me, as well as that you can`t use a ventilator on a LT (I´ve never used a LT in the field, but we have them on the car and I`ve seen it used with a ventilator during my clinical time, furthermore I`ve never seen a remark in the literature regarding to that).

[rock_shoes]

This is a good question, some people may wonder why you would consider upgrading an advanced airway that is already functional. Here are the main reasons; the king airway does not provide a "true" airway, it does not go into the trachea which does not allow you to monitor true end-tidal CO2 the reading is not correct, second you can not put a ventilator on a king airway for the same reason as above and third the king airway is a temporary airway not meant for more than two or three hours at the longest from what I have read.

This does not have to be done in the field but can be very useful. I work for a hospital based ambulance service as well as a private 911 ambulance so I do understand and see both sides. I usually wait until I am at the hospital to exchange for an ET tube so that they can put them on a ventilator. I also don't exchange if it is a code and the patient does not have a perfusing rhythm.

Simply untrue. A King Airway can be used with a ventilator. Is an ET tube preferable? Of course it is. As for end-tidal CO2; readings with a King in place will be accurate enough for use because the device isolates the trachea from the esophagus. That's the whole point behind the distal and proximal cuffs. I would never argue against ET intubation being a higher standard of airway management, but lets not slag one of the best rescue airways currently available.

Looking at the design of the King LTS-D it would also be possible to pass a bougie through the king, remove the king, and use the bougie to place an ET tube. That's one hell of a feature to build into a rescue airway.

For information directly from the horses mouth here's a link to the King LTS-D instruction sheet.

King LTS-D Instructions

[firemedic37]

Yeah, the LT is not a "true airway", as it does not go endotracheal (and therefore, you don`t have the same safety against aspiration that you have with an ET) .

But - that there are problems measuring the etCO2 would be new to me, as well as that you can`t use a ventilator on a LT (I´ve never used a LT in the field, but we have them on the car and I`ve seen it used with a ventilator during my clinical time, furthermore I`ve never seen a remark in the literature regarding to that).

I know that the King Airway was designed for surgery and then used as an emergency rescue airway for EMS. They may put the pt on a ventilator in the hospital setting. I am speaking from an EMS perspective, our protocols state that a patient must have an ET tube in place to put them on the ventilator. Our hospital requires that the patient also be intubated to be put on a ventilator. I guess I should of included this with my earlier post. I believe that this is a local requirement to provide more protect from aspiration and the King is not intended to be used for extended period of time.

Simply untrue. A King Airway can be used with a ventilator. Is an ET tube preferable? Of course it is. As for end-tidal CO2; readings with a King in place will be accurate enough for use because the device isolates the trachea from the esophagus. That's the whole point behind the distal and proximal cuffs. I would never argue against ET intubation being a higher standard of airway management, but lets not slag one of the best rescue airways currently available.

Looking at the design of the King LTS-D it would also be possible to pass a bougie through the king, remove the king, and use the bougie to place an ET tube. That's one hell of a feature to build into a rescue airway.

For information directly from the horses mouth here's a link to the King LTS-D instruction sheet.

Please look at the above comment in regards to being used with a ventilator. I am not against the use of the King airway, I actually pushed for them on our rigs since they are simple and quick to use. They are an amazing airway and they should be used more often. We no longer even carry the Combi-tube since they are not really sized very well and cause a lot more trauma to the patient.

[P_Instructor]

Once you train and use the King, you will find it even easier than the Combitube. As a secondary device for the paramedic, it's great. Our state has even adopted the King as the replacement for the Combitube even at the First Responder level.

[chbare]

Again I ask, how would you justify removing a functional backup device if your swaparoo with a bougie trick failed? I am not saying you are necessarily wrong; however, if your plan to exchange fails, you could be potentially left without any airway. So, I see this as a procedure with questionable benefit and potential disaster written all over it. I am not so sure the benefit would outweigh the risk in this case. Clearly, I am not convinced with any of the "definitive" airway and "aspiration" risk comments at this point in time.

Take care,

chbare.

[rock_shoes]

Again I ask, how would you justify removing a functional backup device if your swaparoo with a bougie trick failed? I am not saying you are necessarily wrong; however, if your plan to exchange fails, you could be potentially left without any airway. So, I see this as a procedure with questionable benefit and potential disaster written all over it. I am not so sure the benefit would outweigh the risk in this case. Clearly, I am not convinced with any of the "definitive" airway and "aspiration" risk comments at this point in time.

Take care,

chbare.

If the King is secure and allowing adequate ventilation then I agree with you. In the pre-hospital environment it would be better to leave the King in place. Once in the hospital things change. If a patient is likely to remain on a ventilator for any amount of time or surgery is required the King should be replaced in hospital. The bougie trick with the King then becomes a very significant advantage over say a Combitube.

Consider also the burn patient. Any burn patient who's airway has been affected requires more definitive airway management than that afforded by a King, Combitube, or LMA.