# King LT tube controversy



## ccfems540 (Aug 15, 2007)

Recently my department decided to use King LT tubes first before intubation on cardiac arrest patients.  I have not had any good experiences using this device.  It is not a true definitive airway.  Has any one else had good or bad experiences with it?


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## Emtgirl21 (Aug 15, 2007)

I think we have actually talked about the King tube on the board before. Our company switched them and really did tell us about it. I rather have my combitube. Matter of fact if i get a truck without a combitube i usually go search the supply room until i can find one. I really just dont care for the King tube. Then again i havent been properly trained with the stupid thing either.


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## Guardian (Aug 16, 2007)

It's a piece of S***, no question.  While people like me have been trying to increase education requirements, most choose to go about business as usual.  Because of this, we see them dumbing down everything.  Have you seen an ACLS class lately?  The "instructors" put in a DVD and press play.  You suffer through having to learn CPR again, I'm not kidding!  To intubate and do other hard skills, you need a certain quality provider.  We don't have enough now.  I see fewer and fewer jonny and roy quality paramedics and more and more bubba emt-paramedic wannabes.  They're hurting our profession.  The king LT is a basic adjunct, slightly above the OPA.


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## Grady_emt (Aug 16, 2007)

We recently started to phase the Combi out with the King after a limited basis trial.   However after receiving mixed reviews from the field crews, we are still ordering Combi's for now as well as the King.  Personally I've used it twice, and one was successful, the other wasnt and we ended up Tubing the guy on the second attempt as we didnt have a COmbi that day on our truck.  Ill give it a little longer, but I still prefer a combi over the king.


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## Onceamedic (Aug 16, 2007)

OK.. so help out a dumb student please...   why would you use either a King or a Combi if you've got the option to intubate ?  Thanks.


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## Grady_emt (Aug 16, 2007)

the one successful King placement we had tried to tube x 2 and handnt been able to get it, then got the king to take appropriately.  The unsuccessful King we had tried x 2 to tube and then tried the king x 2 then finally got the tube to pass.  Just a second option as usual.


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## Onceamedic (Aug 16, 2007)

ahh... gotcha.. too inexperienced to understand that sometimes ya cant get the thing in...   thank you for the explanation.


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## sandboxmedic (Aug 18, 2007)

*King tube Failures*

I stick with the Combi-tube, but, havnt used the king adjunct yet. Although it seems like a combitube cut in half. So, to the folks who have actually used it and say it sucks, how about a little more info. Id like to know a little more about the patient, was it one of those folks who are significantly "anterior", or that 400lb guy, with a horseneck, and 8 chins resting on his chest? Id really only see its "ease" of use on a thin patient, anyone with a thick neck seems like it would be a problem. Fill me in....Thanks!


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## medic258 (Aug 21, 2007)

I have never seen the King. Does anyone use LMA's as a secondary airway device?


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## NeiN11 (Aug 21, 2007)

*LMAs*

I don't like the LMAs because none of my patients have been NPO for 12 hrs.  They're all the rage in the OR...to the point my Parameidc studetns have a difficult time getting their 15 ET placements.


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## medic258 (Aug 21, 2007)

NeiN11 said:


> They're all the rage in the OR...to the point my Parameidc studetns have a difficult time getting their 15 ET placements.



We have the same problem in Mass. There are a couple of services that do use LMA's as a secondary airway. We still use the combitube.


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## triemal04 (Aug 21, 2007)

We've got LMA's where I work as a back up to ET tubes.  They've got their problems; risk of aspriation, very easily dislodged.  At some point in the future we're supposed to go to the King airway as a backup.  From what I've heard the biggest problem is the balloon that inflates to secure it; it will often take more or less than the reccomended amount of air to get a good seal.  (LMA's can also have the same problem)


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## Grady_emt (Aug 22, 2007)

Sandboxmedic:

THe pt who took the king after attempting tubing them was an approx 35yom who decided he wanted to fly to his destination and leave the motorcycle smashed into a concrete pillar.  He had massive facial trauma (faceplant per witnesses when he landed 50' later), copious amounts of blood in his airway, even with continuoous suction unable to visualize the cords.  Pronounced after about 20 minutes at ER (level 1 truama ctr)  

Pt who did not take the king was a middle age female(average size & wt) who had been trapped in a house fire and hade severe inflammation of the airway, again unable to pass the tube through the cords initially, but eventually got it.


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## sandboxmedic (Aug 26, 2007)

HAHAHHAH, had a good laugh on your "flight to destination, however left the motorcycle in place".....Props to ya, that was funny.
dunno, sounds like the moto guy could have taken a combitube as well. I hate the LMA's, and as far as the burn victim, those are always a pain the a** with the sensitive airway. Good job on landing the tube though. Guess id have to use one a couple dozen times to test it out......


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## chico.medic (Sep 5, 2007)

The combi-tube and the King LT are both mediocre at best, and are exactly what they were intended to be: Rescue Airway Devices.  You can't get a tube, you use it as a bridge till you can achieve a definitive airway.  There's really no excuse to not have a tube.  Tough intubation?  Fine, use a bougie, or a fiber scope, or a per-trach.  

I agree w/ Guardian, too many things out there that are dumbing down the profession.  Just my $0.02.


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## spidermedic (Dec 28, 2007)

We've been using the King in place of the Combi for about 18 months and have had no problems. The  BLS services around us have all switched as well. The most common problem is putting enough air in or pulling it back far enough after inflation. 

Personally, I'll take the King over the Combi any day.


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## kiwimedic (Dec 29, 2007)

Interesting.  We don't use the Combitube but the LMA is within our EMT-B scope of practice.  I might have to do some research and take it to management, maybe we can replace the LMA with the King LT.


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## Markhk (Dec 29, 2007)

Someone needs to explain to me why the King airway will "never" go into the trachea. (Which, of course, would be bad.)  That's what the manufacturer and several ER docs I've talked to say, but the only study I can confirm that with is a manikin based one. To me, it seems anytime you have any type of tube, there's a chance it will go into the trachea. 

I guess I'll still just curious on why the King is superior to the Combitube, aside from cost.


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