More Doubt about Paramedic Endotracheal Intubation

[chbare]

Spock,

Thank you for the information on the King LT. My National Guard unit is looking at using the King LT over the Combitube. I have been prowling around the posts looking for someone that has first hand experience with the King LT. I have used the airway on a simulator and found that it was pretty easy insert and manage.

chbare

[Spock]

I am as active in the field as my time permits. My local service is mostly paid but still has a few volunteers. They issued me my own radio and I respond from home on calls near me or I take a response vehicle home and run ALS backup to give the supervisors a break. EMS gets into your blood.

I really think the King has advantages over the LMA. It provides a small amount of protection against gastric aspiration (the LMA provides none) and maintains a better seal when moving the patient. The first person to use the King in our OR was a first year SRNA. She put it in easily. I've used it six times so far and am always looking for a reason to use one. Most of the cases I'm assigned to are not appropriate for a King or LMA.

You can also use higher positive pressures to ventilate a patient with a King as compared to an LMA. We pay $8 for a disposable LMA and $14 for the disposable King. There are three sizes based on height. I would think the King would be much better for prehospital or battlefield conditions than an LMA. Its advantage over the combitube is that with only one lumen there is no decision to make for ventilations. The King came from Germany and was approved for the US in 2005. There is a website but I have it at home and I'm at work right now. Google King.

Live long and prosper.

Spock

[chbare]

Spock,

I think we are getting our King LT's form http://www.narescue.com. There is allot of info and even some research data about the King LT on this website as well. The King seems to be getting allot of good press, but I am always a little skeptical about the latest and greatest devices, so I am happy to hear that someone experienced in airway management gives the King LT two thumbs up. It looks like I will get to use the King LT on cadavers at SLAM next month, I am looking foreword to that experience.

Thanks again,

chbare.

[Ridryder 911]

I am definitely all in favor for exceptional "back-up" airways, secondary to ETI. But, still ETI is the gold standard and still should be the primary airway when needed for securement of an airway. I would like to see studies & citations of this airway.

Again, we need to be sure to correct the problems instead of throwing the baby out with the bathwater..

R/r 911

[chbare]

Ridryder 911,

I completely agree with you. I think ETI is the gold standard for securing the airway and all of the various airway devices out there are backup/rescue devices, or devices that can be used in the OR by someone who has the ability to transition to ETI if required. I actually fear that some people who have pull in the medical community (and who live echelons above reality) will look at these devices as a replacement for ETI in the prehospital environment. I know you are pretty busy with your studies, but I could PM you with some of the data I have on the King LT.

Take care,

chbare.

[Asysin2leads]

I still shake my head at the high percentage of esophageal intubations that reach the ER. You miss, it it happens. You can't get the tube, it happens. But to be in the esophagus and leave it there and drive to the hospital merrily ventilating the stomach? Who is doing this? I really want to know. Lets find these people and ask them. Did you notice the person was turning blue? Did Did you notice there belly was getting very big? etc. etc.

[Spock]

I wasn't suggesting that the King should replace ETI and I agree that more experience is needed with it. I just think it is a better back up than the LMA or the combitube in the prehospital arena. Also, if an EMT can place an OP airway I see no reason why they couldn't use a King LT-D. Using a device 6 times does not make me an expert which is why I still look for cases to use it. I'm currently on the down side of a 24 hour shift. Score for today is 4 ETI's, 0 LMA's and 0 King LT-D's. Yes, ETI is still the gold standard.

Time for coffee. The next surgeon that walks through the door is going to get it right between the eyes.

Live long and prosper.

Spock

[Ridryder 911]

Yeah, I would like more info on the King airway. I agree Ays on their is no reasin why patients still arrive in ER with dislodged or "tube in the wrong place". With all the new advances there is NO EXCUSE !

Spock, since you work in O.R., I am sure you utilize EtCo2 monitoring as a routine as well, do you think we are not using this tool as much to our advantage (on top of the clinical findings) as much as we should ?

R/r 911

[AZCEP]

I must say that the waveform capnograph is a good tool. Unfortunately, too many providers have been told that it will only help with the intubated patient. There seems to be a huge misunderstanding about the utility of the device.

We've recently adopted a policy where the providers print a strip before and after any time they move the patient. We have also tried to encourage eliminating movement as much as possible. Intubate after placing the patient on the gurney, instead of on the floor. Place a cervical collar and C.I.D. once the tube is in place, a tube tamer is only as good as the surface it is secured to.

With help from our medical director, we are reviewing every incident that results in a patient being intubated. We've been issued a standardized form, that covers sedated/RSI'd patients. It will work for all intubations, you just leave the medications used sections blank.

It will take a while to get everyone on the same page, but taken one step at a time, eventually we will reduce the problems.

I do wish that the ER staff was subject to the same type of reviews. I'm sure we could hear the screaming from the ER doc's if they had to answer to anesthesiology.

[resqmdc14]

Between my job and my vol. station, we run about 2000 a year. In that, I might get the opportunity to administer 6 or 7 PVC challenges (ET to the younger crowd). Do I break out the airway manikin once in a while and practice? SURE! You have to with all your skills. Perhaps the best medic in our county is retired from Fairfax County. He has taught me some techniques for tubing that would make your head spin. When is the last time you had to digitally tube a patient with their head sticking through the windshield? That's the kind of stuff we do during drills just to make practicing a little more interesting. As for missing the tube and going stomach...two letters NG. I make it a standard practice that they go hand in hand.

Bottom line, like Rid said, ET is the gold standard. Leave it alone. They want to survey something, work on real issues. Like a Medical Command that is 2 hours away from you but still dictates how you run your scene. But that's another topic I'll bring out on here later.

TTFN