Verde Valley EMS

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• Verde Valley EMS

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Educational Outcome

• To enable EMS providers to appropriately,
  effectively, quickly and safely utilize the King
  LT-D (KLTD) and King LTS-D (KLTSD) airway
  devices in the prehospital environment.

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Advantages of the KLTD/KLTSD

• Easier to place and use.
• One port to inflate
• One tube to ventilate
• Does not require extensive skill training
• Can be placed quickly.
• Provides a means for positive-pressure
  ventilation.
• No interruption of CPR necessary.
• Little or no spinal movement necessary.
• Lower incidence of sore throat and trauma.

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Advantages of the King continued

• Smaller than other devices (e.g., Combitube).
• More cost-effective than other options.
• Minimizes gastric insufflation.
• LTS-D enables passing of gastric tube into
  stomach.
• Comes in various sizes.

3 45 feet 4 56 feet 5 Greater than 6
feet
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Research Experience

• Preliminary research.
• Formal studies of the King LT-D/LTS-D are
  limited, but suggest positive results.
• Prehospital studies of the King LT-D/LTS-D are
  currently ongoing, and others will be published
  soon.
• Research articles available on the King Systems
  website (www.kingsystems.com).
• Other agencies seeing positive results.
• As of February 2007, Clackamas County Fire
  District 1 had done 21 insertions with a 90
  success rate.
• Anecdotal evidence from Clackamas suggests a
  higher rate of ROSC in cardiac arrest patients
  intubated with the King.

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Disadvantages

• Patient must be unresponsive without a gag reflex.

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Design of the King LTS-D
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King LTS-D Design continued
Distal tip and cuff flattened for more anatomical
fit behind larynx
Multiple outlets and bilateral eyelets, in order
to obtain best ventilation
Ramp directs tube exchange catheter out main
ventilatory opening
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Comparison of Tube Sizes
Range 4560 ml
Range 6080 ml
Range 7090 ml
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Indications

• When tracheal intubation indicated, but
  unsuccessful or unavailable.
• Access to the patient is limited (e.g., trauma
  patients, entrapment, etc.).
• Difficult or emergent airways, in which other
  options may not be feasible.
• Cardiopulmonary arrest (optional).

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Contraindications

• Presence of gag reflex.
• Caustic ingestion.
• Obstructed airway.
• Esophageal trauma or disease.

Same contraindications as the Combitube
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Insertion Procedure

• Have all equipment ready prior to attempt.
• Test cuff inflation system for leaks.
• Apply a water-soluble lubricant to the posterior
  distal tip of the device.
• Hold KLTD/KLTSD in dominant hand atproximal
  connector.
• Use a superior (to patients head) approach.
• Perform tongue-jaw lift while keeping headin a
  neutral position.
• Head can be slightly extended or placed in the
  sniffing position if needed to facilitate
  placement.

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Insertion Procedure continued

• With the King LT (S)-D rotated laterally 45-90
  degrees such that the blue orientation line is
  touching the corner of the mouth, introduce tip
  into mouth and advance behind base of the tongue.
• As the tube passes under the tongue, rotate the
  tube back to midline (blue orientation line faces
  chin).

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Patient Insertion
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Insertion Procedure continued

• Without excessive force, advance tube until
  connector is aligned with teeth and/or gums.

It is important that that the King is advanced
all the way.
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Insertion Procedure continued

• Using a syringe, inflate the cuffs with the
  appropriate volume of air.
• Special (reusable) color-coded syringes can be
  utilized.

3 4560 ml 4 6080 ml 5 7090 ml
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Insertion Procedure continued

• Attach BVM to 15 mm connector.
• While ventilating, simultaneously withdraw until
  ventilation is easy and free-flowing.
• There should be good tidal volume with minimal
  resistance.

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Insertion Procedure continued

• Perform standard evaluation of lung sounds while
  ventilating through the King LT-D/LTS-D.
• Attach and utilize end-tidal CO2 monitoring while
  the King LT-D/LTS-D is in place.
• Readjust cuff inflation as needed.
• Consider securing with tape or ET tube holder.
• Securing with tape or ET tube holder not
  required, but recommended.
• With cuffs inflated, King tends to fit snugly and
  securely.

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Proper Position of the KLTD/KLTSD
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The KLTSD Gastric Access Lumen

• Lubricate gastric tube prior to inserting into
  the gastric access lumen.
• Up to an 18 Fr catheter may be utilized.
• Attach suction unit to catheter.
• Once stomach contents are evacuated and suction
  no longer necessary, suction device may be
  detached.
• Catheter may left in place to plug lumen, and
  to continue to decompress the stomach.

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Important Points User Tips

• To avoid tracheal placement maintain head in a
  neutral position. Ventilation will not occur if
  placed in the trachea.
• If unable to ventilate, remove device and
  replace.
• If water soluble lubricant used, do not apply
  near ventilatory openings.
• Be prepared to re-inflate cuffs with another
  1015 cc in the event of air leakage (do not
  over-inflate).
• Insertion depth is critical, as the ventilatory
  openings must align with the laryngeal opening.

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Important Points continued

• Be certain to advance the King LT-D/LTS-D until
  the base of the connector is aligned with the
  teeth and/or gums

Failure to do so may result in a failed
intubation attempt!
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Return of Spontaneous Breathing

• If patient regains consciousness and respiratory
  drive, and is not tolerating the King, consider
  extubation.
• Place them on their side and fully deflate cuffs.
• Gently withdraw the tube.
• Have suction ready and be prepared for vomiting.
• If patient regains respiratory drive, but remains
  unconscious but combative
• Consider sedation with midazolam and vecuronium.
• Continue providing or assisting ventilations as
  necessary.

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Spontaneous Breathing continued

• During spontaneous breathing, the epiglottis or
  other tissue can be drawn into the ventilatory
  openings.
• This can result in obstruction.
• Advancing the King 12 cm normally eliminates
  this obstruction.

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King LTD Airway 2.0 2.5
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Questions?
Questions?
Questions?