King LTS-D

[JPINFV]

heres my point.

Dont say that basics shouldnt be able to use this tool in the field

See, the problem though is that the argument is going to be that EMT-Basics shouldn't be allowed in the field unsupervised [online/standing medical control is not supervision] to begin with. With a minimum of 110 hours of training [per DOT standards], which includes only two hours of A/P and one hour of pharmacology, it is very hard to argue that EMT-Bs should be granted a higher scope of practice. With out a higher scope of practice [the level of education of a level should justifies their scope and a level's scope of practice is what makes them beneficial to a patient], the ability for EMT-B personal to care for a patient past high flow O2 and transport is extremely limited.

See the following examples:

A call to arms! EMT-B's defend yourself!

Basics and Intermediates ONLY No more BLS 911 ambulances?

[afd1307]

Might want to read the rest of what the sentence that you quoted says.

[JPINFV]

Well, if there are no basics then what basics could or couldn't do would be a moot point.

Edit: Let me clarify a bit also. Stating that the EMT-B level is undereducated is a criticism of the system itself, not the individual providers.

[Dustdevil]

Edit: Let me clarify a bit also. Stating that the EMT-B level is undereducated is a criticism of the system itself, not the individual providers.

Unless those providers FAIL to recognise and admit it. In that case, the criticism goes to them personally.

[CBEMT]

You can't change the tube with a bougie. The King airway is designed to go into the esophagus , not the trachea.

So changing the tube out would just place your ET tube in the esophagus!

pwn3d

Another crystal clear demonstration of why EMTs should not be practising with these ALS devices.

It occludes the esophagus, and has a "ramp" at the level of the glottic opening for the bougie to pass into the trachea when properly placed. It is really quite simple to exchange for an ETT if you so desire.

"Pwn3d" indeed. :twisted:

[flyin dutch]

Hmmm . . . so I'm not sure I want to get into this argument but I'm looking for some information. Let me explain my background a little. I work full time as a flight nurse but also am a volunteer EMT-B (conditional "I" through RN exception) for a rural ambulance service in Iowa.

Currently, on flights, our back-ups for RSI include the Combi-tube and then the Melker cric kit. Now that the King Lts-D has come out, there's some rumblings about changing to the King tube instead of the Combi-tube.

At the same time, the medical director of the volunteer BLS squad approached us about changing to the King tube instead of Combi-tube as well. Currently, the Combi-tube is part of our standing orders for any cardiac or respiratory arrest (trauma or medical) that aren't excluded by the Combi-tube contraindications.

What I am looking for is some PUBLISHED studies on the efficacy of the King tube--you know, evidence-based medicine? I've handled the King tube and placed one in a dummy, appreciate the features and everything seems a-ok. But I want evidence before we put them into practice! The King Lts-D is acutally classified by the FDA as an OPA, putting them in every EMS provider's scope of practice. However, the state of Iowa also requires documentation of training and the medical director's approval. Some more food for thought--thanks in advance if any of you have any info on published studies!!

flyin dutch

[chbare]

Try the following link. The studies may be a bit biased however.

http://www.kingsystems.com/EDUCATION/Clini...21/Default.aspx

Take care,

chbare.

[tniuqs]

Far better in my humble estimation and FAR better than the LMA (tis great in the OR but unsuitable / unstable for EMS use) AND a proper cric kit is far better than some of the "scalpel and a chopped off ETT fabed kits" ... kudos to your airside.

So what er "training" does the basic level receive in regards to a successful out come if they have to extubate ? That said: Thing is in most situations is basics are inserting these devices in cadavers, so really what's the harm ?

Ditto, show me the money TOO, as once the cardiac sphincter is dialated with the Combi in the unconscious patient ... lets just say hope you are very quick and have a good suction device, an NG SHOULD be placed prior to removal of either Combi or King, to cover ALL the bases. Are they going to teach that to EMTs ?

I bet the first court case will change that error !

This a definitive "invasion" of the body so to speak, and with a blind inflation of cuff as well:

No IV access? (as in a trauma arrest?) so whats the point here ?

No IV meds?

No background in ETCO2 ..... its sounding kinda sketchy to me .

SO How much malpractice does the MD of the volley squad have ?

Does he work with highschool lifeguards too ... ok, thats just sarcasm.

This is a back up airway for advanced providers ONLY, hopefully a very controlled and diligent eye will kept on that proven "EMT-B" before throwing caution to the 4 winds ....... AGREED.

cheers

then again I could be way too PRO Paramedic, just saying ......

[tniuqs]

Try the following link. The studies may be a bit biased however.

http://www.kingsystems.com/EDUCATION/Clini...21/Default.aspx

Take care,

chbare.

The studies may be a bit biased however

You think ?

I think a comparative study from successful ETT to successful "Airway Adjuncts" This should be undertaken and not sponsored by the Company that stands to profit and increase market share, can't think of any company that would openly post studies that could in anyway be controverial .... just not good buisness practice, and not saying that the King Lt is NOT a good back/up at ALL.

Perhaps a to door discharge ?

I can't for the life of me understand inserting an Airway in a trauma arrest patient without the capability of addressing any of the underlying causes ? for that matter a medical either

BUT once again :The patient was rushed to hospital and pronounced DOA" endangering lives of innocent civilians for zero reason ... sheesh.

Best look to trauma arrest "BLS" outcomes FIRST, If one can follow my ramblings.

just my $00 .0197 @ present conversion rate.

cheers

[Mateo_1387]

From reading through this post for the first time this is what I see and think.

For the first argument about intubations at 70 seconds taking too long I don't think it is a problem, that is only in cardiac arrest. The newest CPR standards, for lay persons, is to do continuous compressions without ventilations, if so desired by the lay person doing CPR. So provided we have effective CPR and extended time of 70 seconds to get a "golden airway" to me should not be a problem. For a patient not in cardiac arrest who is apneic or near apneic 70 seconds for intubation would not be acceptable (example. Pulmonary Edema, trauma, RSI).

Check this link out

http://emscapnography.blogspot.com/2006/08...hould-know.html

On this link find the LP12 about half way down, and three strips below that is a strip showing the gas exchange with CPR alone.

Here is my second thought.

One skill I have seen incorrectly done on every call I have been to where it involved a patient being BVM'd, the skill was done improperly. This is a so called "basic" skill that is essential to master. Using a BVM is a fairly simple skill, just done improperly a majority of the time. Multiple instructors I have had, and anesthesiologist in the OR have told me that it is a skill done improperly most of the time. I am also sure everyone reading this post has been to numerous calls where a person using the BVM is doing the skill improperly.

So now that we have it established that BVMing is mostly done improperly, why in the world do we want to give the KING to basics when what the patient needs first is proper BVMing and an ET tube? Same goes for medics, why would you want to use a King when you should have the skills down to do an ET tube. I think King would make a good backup device in a dire situations, but I think it should be a device that is rarely if never used.