King LTS-D

[joesph]

Tnuigs I pushed your post about the FDA up to the state level citing only the sources and guess what? They are gonna use it anyway, who da thunk.

Edited December 27, 2009 by joesph

[fireflymedic]

Do the paramedics in the areas that are considering this procedure getting enough airway management practice to maintain their ability?

If they aren't, and most places don't, adding one more set of providers with an advanced skill that will not be practiced enough is not the answer. Educate the medics that need more practice so the EMT's won't need another add on skill.

Ummm, I hate to say this, but giving another skill to EMT's because medic's need more practice? I hardly think that is the case. The King Airway is a rescue device for medics with ET intubation still the gold standard. But there are some patients, no matter how hard you try, without some assistance from other toys that are an option within the ER/OR you are not going to get them intubated. I'm sorry, but that's just the case. If I'm picking my back up airway devices, I want a King - not an LMA (to easily unseated and if they start waking up, the potential for aspiration is great), and not a combitube (too much potential for airway trauma creating an even more difficult intubation). Also the king is much easier to intubate around than the combitube. As others have said, the bougie is a great thing - try it and see (and yes preloading it is not that unusual AK )Especially in cases like this - drop your bougie with King in place and you've most likely got your tube.

As for medics not having adequate intubations there is no reason for it except pure laziness on the parts of the departments. It seems when in class, it's all important to make sure your skill sets are good, but I know medics which have gone several years without getting one simply because they haven't been on that few lucky runs that required an intubation (I am aware of one that has worked 5 years and aside from his refresher which is every 2 years and requires one successful intubation on a mannequin he has not intubated). Demand of your training officer, (if that doesn't work start going up the chain all the way to the med director) that you need to adequately maintain your skills. Trust me, when you remind the med director that you're working under his license, he will find a way for you to get intubations because if you screw up it falls back on him, and no doctor wants that. Med directors sometimes forget that, so when you remind them of that they find a way to help you get what you need (if they won't perhaps you need to look for a new med director).

As far as adding them/taking away from basic skill set. It's more simplistic than a combitube, and that is within the majority of BLS service's skill set so why not exchange one for the other? It's meant to be a temporary airway, not long term (less than 24 hours) and will most likely be exchanged for an ET at hospital or when ALS arrives. Let's think about what is best for the patient until ALS arrives or gets to the hospital, and if the King is an adequate airway adjunct or rescue airway I think it will work.

[akflightmedic]

Also the king is much easier to intubate around than the combitube. As others have said, the bougie is a great thing - try it and see (and yes preloading it is not that unusual AK )Especially in cases like this - drop your bougie with King in place and you've most likely got your tube.

I never said it was wrong. It was just so different and "radical" to me. Such a simple concept and I knew nothing of it, I do see the benefit of it and am using the idea here on out. That was my "something new learned every day" for that day...

[fireflymedic]

I never said it was wrong. It was just so different and "radical" to me. Such a simple concept and I knew nothing of it, I do see the benefit of it and am using the idea here on out. That was my "something new learned every day" for that day...

Lol, I'm just pickin on ya AK 'cause I can. Glad you found it useful my friend

[Mateo_1387]

He is what North Carolina is saying about using the King airway for emergency situations.

NC-KingAirwayFDAOpinion.pdf

[JPINFV]

^

Ah... durrr... I have no clue why I never thought to apply off-label use to medical devices like it's applied to pharmaceuticals.

[tniuqs]

Ok first don't hang the messenger!

I introduced this note I received to stimulate some brain cells as I have stated many times substituting a plastic "gizmo's"

instead of improving skills and success rates ETI should be the FIRST GOAL, ALS in a "perfect world" should become the new basic level for all communities, as I dare to have a dream.

Using any "rescue" device WILL cause complications in the continuum of care very simply stated. I have yet to see one Combi, LMA, nor King LT used on any ventilator for any period of time the patient the is ALWAYS ET Intubated in ER hence subjecting the "possible salvageable patient" to yet another procedure. A patients on vents after EMS hand over is an indication that patient possibly will survive, now to be called the positive ventilator sign.

Now that said on the EMT/PCP er BLS ... with previso that an serious educational / in-services precede implementation. Yes by all means use the "gizmos" as the criteria for usage is Apneic and Pulseless and most cases just a impending cadaver anyway. If they pull airway adjuncts off a strictly BLS car ... well that would be folly IMHO.

Question remains are these "devices" improving outcomes/ to door discharge as that is criteria is imposted on all "field" ETI studies ..... is it not ?

Mateo_1387

An interesting spin on the topic, so if I read it right "reclassification" of this device to an Esophageal Obturator is the basis for the discussion ?

Bottom Line for the HUGE Marketing schemes this has the potential ie Combi/LMA/KLT to take away from the profession and become just a "market share" and don't think for a millisecond the developers use every possible crappy little study OR better yet FUND the studies to prove their device is superior based on success rate of "dropping" a tube instead improved outcomes.

I hypothesize there is even a lower chance of to-door-discharge with any obturator device than with ETI ps (as this indicates there is ALS on Scene) I bet my bottom dollar that survival rate LT King vs ETI are far lower the more obturators are used the more the "the cadaver crowd" and working social arrest by BLS will sink "those" studies like the Bismark.

In closing I highly suspect that any obturator device used and have just one complication of Esophageal hemorrhage contributing to death and the lawyers will make huge "precedent", funny how that works with those more concerned with liability than life.

cheers

[treaux]

Having just switched to King LT-Ds from Combitubes as a backup airway, I'm very impressed. I've used them twice in difficult airways and had great results.

As far as EMT-Basics using them, with proper training, it could be useful. There are many rural areas near me where it can take up to an hour for paramedics to show up and I'd much rather have an airway established during that wait.

It all comes down to training. If EMT-Bs are taught to use it and have frequent refreshers on their skills, it will be fine. Just as medics who don't get to intubate a lot need to stay fresh on their skills.

[fireflymedic]

As far as EMT-Basics using them, with proper training, it could be useful. There are many rural areas near me where it can take up to an hour for paramedics to show up and I'd much rather have an airway established during that wait.

It all comes down to training. If EMT-Bs are taught to use it and have frequent refreshers on their skills, it will be fine. Just as medics who don't get to intubate a lot need to stay fresh on their skills.

Couldn't have said it better myself.

[firemedic37]

I keep seeing on here the samething over and over again, why are the EMT-Basic's getting more skills to use? This comes down to your State and what they allow them to do. Simply put some States allow EMT-Basic's to insert a Combitube (My State Allows This), and they are allowing them to use the King airway. I am not aware with what other States are allowing their EMT-Basic's to do, I am just familiar with what my State and my services allows me and my crew to do. An Iowa First Responder can insert a Combitube, yes that is definitely something that most States would never even think about allowing, however they allow it.

I can understand the frustration that you all are experiecing if your State does not allow an EMT-Basic to insert an Combitube but now is allowing them to insert Kings. However I feel that the best thing for all of our patients is the ability for all levels of EMS the ability to establish and maintain a patent airway. I feel that the King airways allow us all to obtain a patent airway that is proven to work and simple to use. Now the question is what type of training are they receiving prior to placing them into service.