King LTS-D

[ccmedoc]

Thats like one attempt per medic..for a YEAR? This study sucks.

Money spent on remediation or mandatory airway classes every six months would be better spent.

edit: I just read the "study" details again..all these failures on a mannequin..wow. This keeps getting worse. I would surely look into remediation...

This study was done with 69 working EMS Providers (45 Paramedics and 24 EMT-Basics). It was conducted in the back of an ambulance using the standard airway mannequin. Providers had no previous training on the King LTS-D airway. ETT and Combi-Tube evalulated first. Allowed 30 seconds to read the King LTS-D instruction card before attempting. Time elements measured time to placement and first ventilation.

[firemedic37]

In 2006 Iowa Department of Public Health reported 1,324 intubations done in the feild. Of those 14% were done by Iowa Paramedics (NREMT-I/99), 14% were done by RN Exception, and 72% were done by Iowa Paramedic Specialist (NREMT-P/98). Of these intubations 65% were done in a rural area probably by a flight paramedic and the other 35% was in a urban area. Just some food for thought.

[ccmedoc]

I may be confusing paramedic for paramedic specialist..In my area specialist is below paramedic. If so..my bad.. :oops:

[firemedic37]

The study actually does not say which level of paramedic was doing this study, did it. I will look into it and get back with you guys.

[JPINFV]

If the study has been published, let me know and I'll see if I can get the entire study.

[spenac]

70.0 seconds does seem like a long time to intubate, however in Iowa state wide paramedic get anywhere from 0.4 (rural) to 5.3 (urban) intubations per year. Paramedics are rarely allowed in the OR or ETI to maintain their skills. And when the paramedics need to intubate a person they are dealing with less than preferred conditions. I understand some Paramedics may intubate a patient a lot faster than others and this is due to the fact that they intubate a lot more people per year. Most services in Iowa do not even run 3,000 calls a year because we are a rural state.

70 seconds is way to long w/o oxygen. If you are not in in less than 30 seconds you need to back out and bag again. Then reattempt. I would not have passed my intermediate class had it taken me 70 seconds on a manikin or on my real patients. If at anytime we went past 30 seconds w/o bagging we failed. The hospital only allowed 20 seconds. I did more than the required number of intubations. The rule I was taught as a basic was to hold my breath when I took a breath I better be back to bagging the patient.

[chbare]

Hmm, I am not sure I would put a hard time requirement on how long I spend in somebodies airway. This will vary greatly from patient to patient. Do you remember your OR rotation? A healthy and properly preoxygenated patient can go several minutes before they desaturate. Again, this will decrease with illness, obesity, and age extremes.

If I have a well oxygenated patient with a good LEMON assessment and all of my equipment ready to go, I am going to slow down a bit. If we pull out of an airway every 30 seconds, we will create a failed airway situation when one does not exist. Most people say 3 attempts and you are through. Why not take a little extra time to position, do a little ELM, and perhaps suction. Then, make every attempt my best attempt.

I never bought into the whole hold our breath thing. This IMHO creates undo stress and distracts you from the task at hand. Have somebody watch your saturations, vital signs, and the patients overall condition while you are in the airway. Let the patient's condition decide when you need to stop and bag them up, not the fact that you are out of breath.

Take care,

chbare.

[spenac]

chbare I am not the most experienced but even when just observing OR I never saw an intubation longer than 30 seconds. The few intubations I have done I have never gone more than 25 seconds from stopping bagging to starting bagging the tube. I do see what your saying about hey I'm going thru the cords but oops its 30 seconds that would be stupid to pull back and restart, just as quick to finish, inflate and bag. If somebody has lots of fluid in mouth I could see some time involved but even when doing rotations on one that I observed with lots of fluids they suctioned then bagged ( re-oxygenated ) then tubed.

What I was taught that you get everything ready including blind positioning.

I do agree that some patients take a long time to de-oxygenate, while others almost instantly start dropping especially the obese.

Holding breath is actually supposed to be your partner. When they have to start breathing again they are supposed to tell you so you can decide what to do.

But I like your approach better to decide when to bag again based on patient. I can not adopt that yet as I have to do Paramedic rotations on same 30 second rule.

[tinman694]

Cool thing about the Kings is the ability to put one down quickly, get the pt. oxygenated, then use a gum rubber bougie and swap it to a regular ET tube. This is a trick we learned and have used successfully a couple of times.

BTW, would recommend any ALS provider to take the difficult airways course---it sure helped me--and you get to try out many other goodies for airways to include the king air.

$.02

[northernmedic]

We have been using combitube as our backup airway for about 10 years and are currently examining either the LMA supreme or King Lt-S to replace it. Most likely we are going with the King for many of the reasons listed previously. It will only be as a backup airway and we will continue to use ETI. We have had the bougie for about 8 years and it is a great, cheap, low tech addition to the airway kit in my opinion. We are also starting to certify all our ALS staff in the AIME course (airway interventions and management education). This is a great course put out towards emergency physicians by the CAEP and should be a really good go.