# King-LT vs. LTSD



## WarDance (Sep 10, 2009)

I am working on getting the mountain rescue team set up with kings but I realized there are two kinds.  Is there a huge advantage with the LTSD?  Is it worth the extra money?  Do you guys think kings in general are worth the money for a crew of basics that would otherwise be using OPAs?


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## Shishkabob (Sep 11, 2009)

Can you USE Kings as a basic at your service?


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## gillysaurus (Sep 11, 2009)

^ It's new in Colorado protocol that basics can use Kings or Combitubes. At the discretion of each medical director, of course.

http://www.dora.state.co.us/medical/rules/500.pdf
Colorado Scope of Practice


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## austinmedic77 (Sep 11, 2009)

the main difference is the addition of the port for gastric tube insertion for suctioning and decompression as well as some medication administration depending on need and protocol.  If you aren't going to drop og tubes then i would suggest not using the ltds secondary to the likely hood of creating a gastric content fountain during CPR additionally this may may a difference in price if you are going to order a lot as the style with the sump port are considerably more expensive.  Also, the LTDS isn't available in the smaller sizes.  As always either style can be used for easy retrograde intubation using a gum-elastic bougie and ETT at the ED or if needed when ALS arrives.  Hope this helps.


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## carpentw (Sep 11, 2009)

The major difference between the King LT and LTSD is the addition of a posterior tube which is used to decompress the stomach to help guard against aspiration.  As a basic, I guess it wouldn't matter which one you got, but I would recommend the LTSD because that additional tube really makes it easy to decompress the stomach.


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## VentMedic (Sep 11, 2009)

austinmedic77 said:


> As always either style can be used for *easy retrograde intubation* using a gum-elastic bougie and ETT at the ED or if needed when ALS arrives.


 
Retrograde intubation?

Why?


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## 8jimi8 (Sep 11, 2009)

In the case that bagging becomes ineffective, or in the case that the ER doc doesn't want anything except an ET.


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## VentMedic (Sep 11, 2009)

8jimi8 said:


> In the case that bagging becomes ineffective, or in the case that the ER doc doesn't want anything except an ET.


 
But why retrograde intubation?  An invasive procedure of this type is hardly necessary to replace an alternative airay.


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## austinmedic77 (Sep 11, 2009)

VentMedic said:


> But why retrograde intubation?  An invasive procedure of this type is hardly necessary to replace an alternative airay.



because in some cases this is placed secondary to a difficult airway or inability to visualize the airway.  The king  is not effective at preventing aspiration or protecting the airway when the patient is regurgitating either actively or secondary to gastric decompression.  No one is advocating it as the only option but it is an option and not a bad one depending on the circumstances.  If you had trouble the first time and need to replace the king with a ETT why take the unneeded risk of removing the tube only to be unable to place a new one.  The practice of using the LT, bogie and an ETT is one that is good to have in your box.  it is also being taught to MD's and RRT as well as CRNA's in Texas at all three of the hospitals attached to med schools here.  You may not agree with it but I have had more then one RT in the field on HEMS be thankful they were taught this when they had an actively vomiting pt in the bird and the ease and speed with which they were able to pass the ETT using the bogie to replace that King that was no longer working.  Not to mention the success that the medics docs and folks have had using this technique in Iraq and Afghanistan.


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## VentMedic (Sep 11, 2009)

austinmedic77 said:


> because in some cases this is placed secondary to a difficult airway or inability to visualize the airway. The king is not effective at preventing aspiration or protecting the airway when the patient is regurgitating either actively or secondary to gastric decompression. No one is advocating it as the only option but it is an option and not a bad one depending on the circumstances. If you had trouble the first time and need to replace the king with a ETT why take the unneeded risk of removing the tube only to be unable to place a new one. The practice of using the LT, bogie and an ETT is one that is good to have in your box. it is also being taught to MD's and RRT as well as CRNA's in Texas at all three of the hospitals attached to med schools here. You may not agree with it but I have had more then one RT in the field on HEMS be thankful they were taught this when they had an actively vomiting pt in the bird and the ease and speed with which they were able to pass the ETT using the bogie to replace that King that was no longer working. Not to mention the success that the medics docs and folks have had using this technique in Iraq and Afghanistan.


 
But why do you feel it necessary to cut someone's throat open?

If you are going to do that, you might as well do a perc trach.

This picture shows *retrograde intubation*. While you could probably use a bougie to pull the tube through, why? In all of my years (30+) as a Paramedic and RRT I have only done this 2 x in the field, both on kids, and assisted a handful of other times in the hospital. While I know how to do this procedure, I would NOT want to make it a habit to change an alternative airway either in the field or in the hospital. If I must cut someone's throat open, I use a trach.


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## Akulahawk (Sep 11, 2009)

Retrograde Intubation and use of a Bougie to introduce an ETT are two different procedures that result in ETI. Retrograde Intubation requires that a catheter be introduced through the cricothyroid membrane and a guidewire be run through that catheter, between the vocal cords, into the pharynx and out the oropharynx. The guidewire is then passed through the lumen of the ETT and the ETT is advanced down the guidewire into the trachea. With a KT, the wire would come out of the opening of the KT... and you'd remove the KT and introduce the ETT in the usual manner for this technique.

Using a Bougie with a KT is fairly simple, but caution must be maintained because you don't want to lose the Bougie placement when you remove the KT. The ETT just slides into position over the Bougie...

See how the two procedures are a bit different?

Vent: that pic was the same one I was going to use...


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## austinmedic77 (Sep 11, 2009)

****Retrograde: to move in a direction contrary to the usual one****


This term is used to describe intubating a pt using a bougie to maintain the airway while removing the king LT (retrograde) and passing a ETT into the trachea over the bougie.  I am glad you are able to make yourself feel better because I chose to use the term that is commonly used to describe the procedure of using a bougie to replace a King with an ETT so as to avoid confusion.  People have decided to shorten the procedure to retrograde intubation when it is in fact called Retrograde Guidewire intubation and is another type of retrograde intubation but not the only type.  Your both quick to point out others perceived mistakes but then make one yourself. Guidewire intubation is not the only type of retrograde intubation.  I have included the definition of retrograde at the top for your reference.  No one claimed they were the same procedure and I didn't reference a guidewire once during my post so I don't see how there could be any confusion between the two.  And yes I see the difference between the two but dont see how using the term retrograde could cause you to confuse the two unless you are not familiar with the proper term for the procedure you are describing.


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## VentMedic (Sep 11, 2009)

austinmedic77 said:


> ****Retrograde: to move in a direction contrary to the usual one****
> 
> 
> This term is used to describe intubating a pt using a bougie to maintain the airway while removing the king LT (retrograde) and passing a ETT into the trachea over the bougie. I am glad you are able to make yourself feel better because I chose to use the term that is commonly used to describe the procedure of using a bougie to replace a King with an ETT so as to avoid confusion. People have decided to shorten the procedure to retrograde intubation when it is in fact called Retrograde Guidewire intubation and is another type of retrograde intubation but not the only type. Your both quick to point out others perceived mistakes but then make one yourself. Guidewire intubation is not the only type of retrograde intubation. I have included the definition of retrograde at the top for your reference. No one claimed they were the same procedure and I didn't reference a guidewire once during my post so I don't see how there could be any confusion between the two. And yes I see the difference between the two but dont see how using the term retrograde could cause you to confuse the two unless you are not familiar with the proper term for the procedure you are describing.


 

For those of us who can do both procedures as have been described in the recent posts, some of us prefer to use "retrograde intubation" in the usage as it has been known for several decades which is what Akulahawk and I have posted. If you are not familiar with the procedure it is easy to see your confusion. 

The bougie and the King were already discussed in this thread.
http://www.emtlife.com/showthread.php?t=14703


Retrograde Guidewire intubation? You need to surf a little more for all the information as well as read my posts in their entirety. 

Now, are you doing the retrograde intubation with the incision and "guidewire"? Have you ever done one?

We also use various devices when changing out ETTs. There is not always a special name since there are many different devices and techniques. However, in all of them, the ETT is still entering the same direction through the mouth and not coming in from the throat. The other tube (King, Combitube) is exiting the same way a tube should exit and NOT in the opposite direction. For it to be "retrograde" it would exit opposite of how it normally would leave. I believe that is the same definition you just quoted:



> Retrograde: to move in a direction contrary to the usual one****


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## austinmedic77 (Sep 11, 2009)

first you are the one that posted a picture of a retrograde guidewire intubation are implied that that was a picture of retrograde intubation.  Again this is a typr of retrograde intubation not the only type.  Additionally if this isnt what you meant then you need to research better and post a picture of what you do mean.  Furthermore:

ret·ro·grade  (rtr-grd)
adj.
1. Moving or tending backward.
2. Opposite to the usual order; inverted or reversed.
3. Reverting to an earlier or inferior condition.
4. Astronomy
a. Of or relating to the orbital revolution or axial rotation of a planetary or other celestial body that moves clockwise from east to west, in the direction opposite to most celestial bodies.
b. Of or relating to the brief, regularly occurring, apparently backward movement of a planetary body in its orbit as viewed against the fixed stars, caused by the differing orbital velocities of Earth and the body observed.
5. Archaic Opposed; contrary.

As the definition clearly states removing a king LT would be retrograde (moving or tending backward, opposite to the usual order; inverted or reversed) to its stated normal intent of introduction into the esophagus to facilitate assisted or mechanical ventilation.

My original post was very clear and accurate and would only confuse someone that is looking for a way to try to make themselves look intelligent in the uninformed eyes by making an inaccurate statement and then trying to pass it off as fact.  I never implied that my example was the only example of retrograde intubation however, you implied that your example was.  Just another example of you trying to get people to believe that just because you say something on this post it is fact and god forbid someone disagree with you or show evidence to the contrary of your views, cause you could never be wrong.


Additionally, retrograde is never referring to the introduction of the ETT it is referring to the removal of the existing device or introduction of the guidewire inversely through the incision.  Retrograde of an ETT would be commonly refered to as extubation.


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## VentMedic (Sep 11, 2009)

*Look at the photo I posted.* Do you see the direction the tube in the retrograde intubation is going? That is "opposite" or contrary to the way a tube or intubation initiation usually goes.

Let me see if I can make this simple for you.

When you intubate someone you go through the mouth, through the cords and into the trachea. That is the normal process. For retrograde, you start the procedure from below the cords through the trachea, through the cords and out the mouth. This is not the normal route thus it is "retrograde" or contrary to the usual. Your *guidewire* could be the bougie.

To extubate or remove a tube, you move that tube away from the cords out the oral route. That is the normal process. There is nothing contrary or abnormal when you remove an alternative airway in that direction. That is the preferred route. 

When you insert the King, you are doing the normal direction as you would for intubation except the goal is into the esophagus. When you remove or extubate the King, again, it is coming out the direction expected. If it was to be "retrograde", we would go opposite of the expected. We do not extubate through the belly if we can avoid it or unless someone really screwed up with their "retrograde" intubation or extubation.


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## VentMedic (Sep 11, 2009)

austinmedic77 said:


> Additionally, retrograde is *never* referring to the introduction of the ETT it is referring to the removal of the existing device or introduction of the guidewire inversely through the incision. Retrograde of an ETT would be commonly refered to as *extubation*.


 
Please, READ and LOOK at the pictures:

http://www.google.com/search?hl=en&source=hp&q=retrograde+intubation&aq=f&oq=&aqi=g4

Yes, the guidewire (or whatever device) goes through to guide the ETT down but the "intubation" part is* initiated* below the cords. Extubation does not go through the cords down the trachea and out the chest some place.

I can see what you are saying since the ETT is traveling the only way it can. But, from the point of intubation *initiation,* the procedure is still considered "retrograde". The guidewire is your intubation tool from the trachea just like the bougie is your intubation tool orally.

Again, have you ever done a true retrograde intubation?  Do you call that "extubation" if you are placing a tube?


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## VentMedic (Sep 11, 2009)

VentMedic said:


> Do you see the direction the *tube* in the retrograde intubation is going? That is "opposite" or contrary to the way a tube or intubation initiation usually goes.


 
Correction: guidewire 

This is the intubation tool from the opposite direction.  Thus the point of intubation is initiated opposite or contrary to the usual just as the definition provided by austin.


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## austinmedic77 (Sep 11, 2009)

the picture you posted shows the guidewire passing through the incision in the neck into the oropharynx where typically forceps are used to retrieve the wire out of the mouth at which time the tube is passed over the guide into the mouth and through the cords into the trachea then the wire is removed as it is no longer needed.  The introduction of the guide is the retrograde portion of the picture YOU posted so maybe you need to look at your own picture.  Also, you refer to my post incorrectly.  Intubation of the trachea by introducing the ETT into the trachea by any means is anterograde: moving forward (into the trachea) and extubation of any airway is by definition retrograde: reversed, inverted, tending backward (out of the trachea) this is the opposite of their intent you don't walk around with an ETT in your throat all the time therefore the atnterograde procedure would be placing the tube by whatever means and the retrograde would be moving it in the opposite direction whether it be removal repositioning ect..  In the picture you show the retrograde portion is the guidewire that is moving in the opposite retrograde direction from the cricothyroid membrane to the ortopharynx.  I will apologize if I am coming across as as confrontational but this is one case where you are wrong.  I will admit that usually you are correct in what you say and I agree with much if not most of what you post on here especially your views on education but I can't abide the misinformation here.


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## VentMedic (Sep 11, 2009)

Okay let's start at the beginning about retrograde intubation.

It is a procedure done when the oral route is consider difficult for some reason which could be trauma, congenital or surgical. The procedure has largely gone to the wayside due to improved cric kits, trachs and fiberoptics. 

Instead of trying to find the trachea from the oral route. A guidewire (in the kit) or some device is inserted through an incision in the trachea. It is then maneuvered up through the cords and out the mouth. Thus, the patient is *intubated in reverse* with a guidewire or bougie type/tube introducer device. The ETT can then be passed over the guidewire through the mouth and through the cords. So "that" part is normal but the intubation procedure itself is still considered retrograde because it was initiated in reverse.

When a patient is extubated, the preferred and NORMAL or USUAL route is opposite of the way the tube went in. Thus, if an ETT, King or Combitube goes through the mouth, it should come out in the opposite direction but that is the usual or normal route so it is not "contrary". Even in the case of retrograde intubation, the normal or preferred route of extubation would be out the mouth so that also is not contrary to the preferred.


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## VentMedic (Sep 11, 2009)

austinmedic77 said:


> (into the trachea) and extubation of any airway is by definition retrograde: reversed, inverted, tending backward (out of the trachea)


 
So why are you using the term "retrograde intubation" if you are referring to the tube that is being removed?

The bougie/ETT are still going forward in a normal manner and not opposite regardless of what the King is doing.     That is the "intubation" part.


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## austinmedic77 (Sep 11, 2009)

They are not intubated in reverse they are intubated normally through the mouth it is accomplished via a guidewire that is inserted retrograde in stead of the typical way of introduction with the facilitation of a laryngoscope.

Intubation: The process of putting a tube into a hollow organ or passageway, often into the airway. The opposite of intubation is extubation. 

The intubation is by definition the insertion of the ETT so if it goes in the mouth it is anterograde passing from in to out whether its the guidewire, ETT or King LT is retrograde as you are reversing the procedure from its intended use and direction of insertion.  As intubation only refers to the passing of the tube into the hollow organ by definition then retrograde refers to the opposite of normal.  Yes the guidewire is retrograde as it is opposite of the way things normally enter the oropharynx.  Your bullying isn't going to change the facts or the definitions.  You seem to imply that the introduction of the guidewire is the act of intubation and that is completely opposite of the definition of intubation as you are passing something out of the hollow organ not into it.


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## VentMedic (Sep 11, 2009)

Okay Austin, you almost have it.



> Intubation: The process of putting a tube *into* a hollow organ or passageway, often into the airway


 



> The opposite of intubation is extubation.


 
If you are going *into* the hollow organ or passageway (airway) you are are intubating. Thus if you are *removing* a tube, you are extubating. If you are performing a retrograde intubation, you are placing a tube *into* a hollow organ or passageway but in a manner contrary to the usual. You are not removing the device. The intent of intubation is to place a tube "into" thus intubation - *in*- *tube* - ation.

Do you at least understand what "retrograde intubation" is and why it is done or as it is called by the "standard" terminology? Do you not think this is a procedure or for decades doctors didn't know how to correctly name this procedure? Were all of those doctors on all the links I posted wrong in calling this procedure "retrograde intubation"?  This is NOT about what I think.


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## austinmedic77 (Sep 11, 2009)

because the king lt is removed after placing the bougie (removed:retrograde) the the ETT is intubated (entered/passed/moved forward:anterograde) with the assisstance of a bougie instead of the layngoscope. it is a conjunction of two words to refer to a procedure just as retrograde intubation in your scenario refers to the procedure of retrograde guidewire intubation but is used as a shortened interchangable abbreviation of the correct name for the procedure.  I suppose i should have called it King LT with Flex Guide Endotracheal Tube
Introducer (gum-elastic bougie) retrograde intubation to be 100% accurate instead of the abbreviated retrograde intubation which can mean any of the retrograde intubation procedures and not just the aforementioned King LT bougie procedure or your mentioned guidewire method.


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## austinmedic77 (Sep 11, 2009)

Do you at least understand what "retrograde intubation" is and why it is done or as it is called by the "standard" terminology? Do you not think this is a procedure or for decades doctors didn't know how to correctly name this procedure? Were all of those doctors on all the links I posted wrong in calling this procedure "retrograde intubation"?  This is NOT about what I think.[/QUOTE]

I am well aware of how the procedure you are describing is and how it is done however when you (or any one for that matter, including doctors) refers to said procedure they are in fact using an acceptable abbreviation of the correct name of the procedure.  I cant be any more clear I have posted the definitions for you and pointed out the flaws in your explanation and logic  You cant argue definition or that you are using an abbreviation.  I'm sorry that you have been using an abbreviation for what you say is 30 years and apparently don't know that it is an abbreviation that refers to many different types of retrograde intubation not just your version. I don;'believe it is malicious it is just  the accepted use of an abbreviation and no one has ever corrected you or them because they know what type of retrograde intubation they are referring to and don't need to further clarify.  However I also and the others reading this post know what type of retrograde intubation I was referring to as we are in a thread about the King LT and don't need to further clarify.  You are trying to argue an inaccurate statement and obviously no matter how much evidence to the contrary you wont admit it.  No one said you were wrong about referring to your procedure as a retrograde intubation but I was not wrong either.  I have and continue to agree that the type you refer to is a type of retrograde intubation it just is not the only type and to infer that it is is WRONG that's right I said the dreaded words and will probably get banned from the site now cause i said the all mighty ventmedic is wrong and then had the audacity to do something silly like back it up with evidence.  You keep trying to make your point but just keep proving mine.  I quote the entire definition and you pick the parts of it you like and ignore the rest.  Extubation is a the removal of an ETT and is a retrograde or reverse procedure.


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## VentMedic (Sep 11, 2009)

Retrograde does not mean removed. 

Here is an example of a retrograde intubation with a bougie.
http://www.anesthesia-analgesia.org/cgi/reprint/105/6/1720.pdf

Maybe you write the authors of this article to tell them that they are WRONG. This is not retrograde intubation by YOUR definition. 

When the bougie is used in the normal manner, it "intubates" the airway in the "normal" direction. If you remove it BEFORE the ETT is introduced, you are not intubating. It then facilitates intubation with the ETT. The bougie intubates the airway in the same direction as the ETT. There is nothing "retrograde" about it as it refers to the act of "intubation" or placing a tube. 

The word "retrograde" applies to the manner the intubation is performed. If we were to remove the tube opposite of the normal method of removal, it would be retrograde EXTUBATION. This may apply in rare cases to some types of ETTs placed surgically. It may also apply to some GI tubes that go into the GI tract one way but may be removed another way later. 

However, if the tube goes out as expected or in a normal manner and not contrary, it is just extubated. We don't use the word "intubation" to describe the removal of a tube. The tube being removed is "extubated". The tube being inserted is "intubated". This is regardless of what device to facilitate intubation is being used. 

If we use a fiberoptic scope to assist intubation, it is a fiberoptic intubation. If we use a bougie, it is a bougie intubation for documentation purposes. If we say it is a retrograde intubation, we mean we have come in from the trachea to facilitate intubation. If we scope someone with a tracheotomy to view just below the cords or even above, we may enter the trach incision and do a retrograde view. That means it is a route opposite of normal for documentation purposes.

If you remove a King tube, you are extubating that tube. It is not retrograde because extubation is the removal of a tube and you are not going "contrary" to extubation so it is not a retrograde extubation.

If you place an ETT, you are intubating that tube. If it is going in the regular way, it is a not retrograde intubation as the bougie or whatever facilitating the intubation is going in the usual direction.


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## austinmedic77 (Sep 11, 2009)

extubation by definition is the reversal of intubation or the removal of an ETT in the reverse that it was placed and as such is a retrograde procedure (retrograde:reverse) 

And you are correct if I intubate only using the bougie it would be a standard intubation with the use of a bougie.  However once the King is introduced into the mix and is removed, extubated to facilitate ETT placement it is then removed in a retrograde procedure and the patient is intubated via the bougie thus being done in reverse something else is placed then removed retrograde to introduce an ETT.  This patient isne extubated and then later intubated iy is a fluid procedure.  And yes again you could use a bougie in place of a guidewire as they descibe in the article and it would be another type of retrograde intubation, it is just a variation of the aforementioned procedure so in that case it could be refered to with the accepted abbreviation or more accurately a cricothyrotomy with retrograde bougie intubation as the intubation refers to the end act of passing the tube into the trachea not the procedure of cutting the membrane and passing the bougie the only thing that makes this retrograde is that it is exiting the trachea/body through the mouth just as the King LT is in a retrograde fashion prior to intubation in either case in an anterograde fashion.  your not gonna cut the membrane and pass the tube form there into the oropharynx thus in the retrograde fashion.  Obviously this isnt going to get resolved as I have provided evidence that i believe proves my point and you think you have proven yours so we will agree to disagree.


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## austinmedic77 (Sep 11, 2009)

con·trar·y  (kntrr)
adj.
1. Opposed, as in character or purpose: contrary opinions; acts that are contrary to our code of ethics.
*2. Opposite in direction or position:* Our boat took a course contrary to theirs. See Synonyms at opposite.
3. Music Moving in the opposite direction at a fixed interval: playing scales in contrary motion.
4. Adverse; unfavorable: a contrary wind.
5. also (kn-trâr) Given to recalcitrant behavior; willful or perverse.
n. pl. con·trar·ies
1. Something that is opposite or contrary.
2. Either of two opposing or contrary things: "Truth is perhaps . . . a dynamic compound of opposites, savage contraries for a moment conjoined" (A. Bartlett Giamatti).
3. Logic A proposition related to another in such a way that if the latter is true, the former must be false, but if the latter is false, the former is not necessarily true.
adv.

seeing as how when you remove a king LT or extubate it from the esophgagus you are moving it in the opposite direction of the process of intubation then it is by definition contrary and as such is retrograde by your chosen lone definition of retrograde as well as the other definitions or retrograde.


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## VentMedic (Sep 11, 2009)

The words "removal" and "reverse"  or "retrograde" are not the same in the world of medicine. We are not talking about the wind, moon and ethics.

Here's another example: 

*cardiac catheterization* passage of a small catheter through a vein in an arm or leg or the neck and into the heart, permitting the securing of blood samples, determination of intracardiac pressure, detection of cardiac anomalies, planning of operative approaches, and determination, implementation, or evaluation of appropriate therapy.
*retrograde catheterization* passage of a cardiac catheter against the direction of blood flow and into the heart.


Note that they did not say "remove" catheter. They are going opposite.


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## austinmedic77 (Sep 11, 2009)

Thats because they are using the term to refer to the opposite direction of blood flow not the act of inserting or removing the catheter but the process of passing it in the opposite direction of the blood flow.  The word can and is used in more then one way thus the multiple definitions.  When you remove a King LT it is in the opposite direction of the intent of its purpose iy works when it is inserted not when it is removed so again in your example they are referring to the opposition to the flow of blood but they aren't moving the catheter in the opposite direction of its intent thus they are inserting the catheter anterograde to the heart but retrograde to the flow of blood or reverse, contrary (insert definition of retrograde here).  Medicine does not change the definition of words it applies the words of the language in question to describe their procedure plain and simple and a complex multifaceted procedure will require the use of multiple descriptive words thus retrograde guidewire (referring to the guidewire) intubation (referring to the ETT)


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## VentMedic (Sep 11, 2009)

What's the use... You already made your point that you know more than any doctor when it comes to retrograde intubation.

However, you really need to know the difference between intubation and extubation. One is inserting a tube and one is removing a tube. Don't use the word "intubation" if you are removing that tube.

I can hear the attorney now:

When you say you intubated the patient in a retrograde manner, you established an airway?

You: No, I pulled it out.


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## austinmedic77 (Sep 11, 2009)

you aren't intubating in reverse are you placing the tube from the lung to the oropharynx? No you are doing a part of the procedure in the opposite of normal ie passing a guidewire from the trachea into the mouth or removing a King LT the opposite of how it was placed in order to then pass the ETT or intubate in the normal manner through the mouth and into the trachea.

And I'm sorry I don't ever remember saying I was or implying that I am smarter then a doctor (although just like you I know I am smarter then some of them) you want everyone to believe that because a doctor refers to a procedure by a abbreviated or generic term that they don't know the proper term, that is your implication not mine.  I'm sure they if questioned would know the additional words associated with your procedure but as it has been commonly for years referred to by its abbreviated name would like anyone else call that retrograde intubation as would I.  I just recognize that this is not the ONLY type of retrograde intubation.


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## austinmedic77 (Sep 11, 2009)

VentMedic said:


> What's the use... You already made your point that you know more than any doctor when it comes to retrograde intubation.
> 
> However, you really need to know the difference between intubation and extubation. One is inserting a tube and one is removing a tube. Don't use the word "intubation" if you are removing that tube.
> 
> ...



I am glad you think that you know me I don't presume to know you.  While the common term for removing an ETT tube is extubation and is the term I use it is in fact by definition a retrograde  and I have posted here and could gladly if asked in court produce the evidence to support that:

"is there any other term that could be used to describe an extubation?"

"Yes per definition, and here are the definitions, it could also be called a retrograde or removal of the ETT, however that term is also used to describe many other procedures and would not be appropriate when documenting a removal of an ETT.  It could be used to describe (insert procedures of choice here)"

I never stated that I would document an extubation as a retrograde intubation and never implied that an extubation in and of it self was anything but retrograde unless another tube is inserted to replace it thus making it a retrograde-intubation.


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## VentMedic (Sep 11, 2009)

austinmedic77 said:


> you aren't intubating in reverse are you placing the tube from the lung to the oropharynx? No you are doing a part of the procedure in the opposite of normal ie passing a guidewire from the trachea into the mouth or removing a King LT the opposite of how it was placed in order to then pass the ETT or intubate in the normal manner through the mouth and into the trachea.
> 
> And I'm sorry I don't ever remember saying I was or implying that I am smarter then a doctor (although just like you I know I am smarter then some of them) you want everyone to believe that because a doctor refers to a procedure by a abbreviated or generic term that they don't know the proper term, that is your implication not mine. I'm sure they if questioned would know the additional words associated with your procedure but as it has been commonly for years referred to by its abbreviated name would like anyone else call that retrograde intubation as would I. I* just recognize that this is not the ONLY type of retrograde intubation*.


 
All you have done is describe "extubation" of the King tube and called that "retrograde intubation".  

This is not new.  We have been INTUBATING with alternative devices in the throat for over 30 years.  The EOA and EGTA have been around for a long time.   Retrograde intubation has been around for at least 50 and it should not be confused with the act of pulling a tube out or "reversing" the tube.   

I have linked you to where you can read and listen to many doctors describe "retrograde intubation".  This is not just one doctor.    Why do you think that these doctors are just making up some  abbreviated or generic term?    Why are you confusing words for procedures that have long been established?   You either don't have a good grasp of intubation AND extubation or just don't understand the importance of proper medical terminology.   

It is really not that difficult.  If you are intubating a tube, you are not pulling it out.  If you are extubating a tube, you are not inserting it.


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## Akulahawk (Sep 11, 2009)

austinmedic77 said:


> I am glad you think that you know me I don't presume to know you.  While the common term for removing an ETT tube is extubation and is the term I use it is in fact by definition a retrograde  and I have posted here and could gladly if asked in court produce the evidence to support that:
> 
> "is there any other term that could be used to describe an extubation?"
> 
> ...


To be both precise and absurd how about using the following terms:


antegrade tracheal tubation
retrograde tracheal tubation
Please note that I have avoided the prefixes "in-" and "ex-" for these...

(Might I also suggest that we create a new thread as this one got hijacked...)


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## VentMedic (Sep 11, 2009)

austinmedic77 said:


> "is there any other term that could be used to describe an extubation?"
> 
> "Yes per definition, and here are the definitions, it could also be called a retrograde or removal of the ETT, however that term is also used to describe many other procedures and would not be appropriate when documenting a removal of an ETT. It could be used to describe (insert procedures of choice here)"


 
Retrograde what? You say "retrograde intubation" when you are removing a tube? 

Retrograde extubation? What is different about it? What type of surgical airway are you working with? 

I'm going to retrograde the ETT? 




Akulahawk said:


> (Might I also suggest that we create a new thread as this one got hijacked...)


 

Since we are using these terms and still discussing "retrograding the King" we haven't gotten that far of track.


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## austinmedic77 (Sep 12, 2009)

and you are taking two terms that describe two different potions of the procedure and trying to combine them into just the act of intubation.  Per my OP I am refering to the removal of the King LT as the retrograde portion and the Insertion of the ETT as the intubation just as the Retrograde guidewire refers to the placement of the guidewire into the mouth and the intubation refers to the act of passing the ETT over it and into the trachea as you keep pointing out its real simple to understand.  Just like you separated in-tub-ation you also need to separate the words in Retrograde guidewire intubation to adequately describe your procedure.  Your not refering to just the act of passing the ETT in your procedure just as I am not referring to only removing the King LT.


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## austinmedic77 (Sep 12, 2009)

ret·ro·grade (rtr-grd)
adj.
1. *Moving or tending backward.*
2. Opposite to the usual order; inverted or* reversed*.
3. Reverting to an earlier or inferior condition.
4. Astronomy
a. Of or relating to the orbital revolution or axial rotation of a planetary or other celestial body that moves clockwise from east to west, in the direction opposite to most celestial bodies.
b. Of or relating to the brief, regularly occurring, apparently backward movement of a planetary body in its orbit as viewed against the fixed stars, caused by the differing orbital velocities of Earth and the body observed.
5. Archaic Opposed; contrary.

Retrograde again by definition.  So yes you could by definition say the King LT is retrograded (Moved backward from its insertion, reversed)

However you again imply that I am using these terms independently which I am not.  When you use the terms together they describe what is being done:  King LT: removed/retrograde movement ETT:intubation/anterograde movement


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## VentMedic (Sep 12, 2009)

I gotta say austin, I haven't met many people that didn't understand what intubation and extubation meant.  You are amongst the very few.  

You have also totally changed your own "wording"  of retrograde intubation when Akulahawk gave you a few new terms to play with.


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## JeffDHMC (Sep 12, 2009)

I love it when people offer an argument and then can't sort the difference between your and you're, or there and their. I love that that s**t.  I just cancelled my trip to Austin.


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