LMAs

[stcommodore]

I don't think 'liking' the LMA is the problem it just isn't pratical for many/most EMS services. Any fool can shove that in someones mouth but it does alot of good if it comes out half way to the ED.

[Classair]

Any fool can shove that in someones mouth but it does alot of good if it comes out half way to the ED.

I found they stay in place if you use a tube holder. Our company uses the EndoGrip.

(Excuse the cut and paste)

The EndoGrip™ features a simple two-piece construction that promotes quick applications, strength and easy repositioning of the tube from side to side. Patented* and FDA cleared clamp is engineered to secure all standard adult-sized ET tubes, including cases of severe facial burns, lacerations, copious bleeding, vomiting or bearded patients. Flexible and cushioned Velcro® strap fastens to itself and not patient's face or head. Acts as an effective bite block, allowing a large portion of the patient's mouth to remain accessible for suctioning.

[stcommodore]

But does the Combi or King LT offer better ventilation then the LMA? The LMA at no fault of the device was designed for the OR and not for the street.

[Classair]

stcommodore,

Contraindications of each are about the same.

Combi comes in two sizes Standard Combitube and Combitube SA

King comes in three sizes 3, 4 and 5

LMA comes in eight sizes 1, 1 1/2, and so on to 6

Ventilation I am sure is based on the size of the tube like a size 2 for an infant / child from 10 to 20 kg would have less air flow than the size 5 for a large adult 70 / 100 kg. I bet someone has done ther homework before manufacturing the product. And with the right Vol. of air in the cuff I have had no problem with dislodgement they also seem to be a bit faster, but that may be just me?

[Spock]

My experience in the operating room leads me to believe the King will ventilate better than the LMA because the King seats better. The LMA can be highly positional and you can readily lose the seal when you move the patient. You can also ventilate the King at higher pressures (30cmH2O) than the LMA (20cmH2O). I have about ten years of experience with the LMA but have only been using the King for six months. Time will tell but I do like the King better and have stopped using the LMA. My experience with the combitube mostly consists of changing one for an endotracheal tube in the DEM or trauma bay. Not fun.

Drawback for the King is it does not come in pediatric sizes. There have been many comments along these lines in other forum areas.

Live long and prosper.

Spock

[taff3432]

It is interesting to see the differences between the US Ambulance Services. In the UK it is different again. I agree that no adjuct should replace good basic airway management. All to often I see Paramedics going for Gucci kit first before ABC, which is what we have all been trained in regardless of level of training.

BLS

ILS using Oro, Naso, LMA then combitube if needed.

ALS then only if required should intubation be used to secure the airway.

In all honesty if you are trained to intubate why bother with the combitube. Another reason I do not like ths is due to the fact that I would never use one in trauma as you may need to move the patients head for a correct placement. So with this in mind I would either opt of LMA or intubate.

[HellsBells]

I never have used either combie, or LMA in the field, but from what I understand aspiration is more of a possibility when using the LMA. Any thoughts on this?

[Spock]

You are correct the LMA provides zero protection against gastric aspiration. The King provides protection from passive gastric aspiration but not from active emesis. The gold standard for preventing gastric aspiration is a properly placed endotracheal tube with a properly inflated cuff.

I couldn't agree more with the statement that basic airway techniques must precede advanced techniques. When paramedic students come to our operating theater for intubations they must demonstrate they can bag the patient before we let them near a laryngoscope.

Live long and prosper.

Spock

[iMac]

I was trained to use LMAs and Combitubes. It was part of our scope up until last year but will at some point will be coming back. They are both user friendly and came and will make a huge difference over an OPA.

I much rather seeing those EMTs out there using them over OPAs

[Xnekal]

How is it that LMAs are being used in the field BLS when the pt has to be NPO because the LMA doesn't protect against emesis. Also do you have the ability to autoclave them for reuse