# King Vision LS



## ABQmedic (Jun 29, 2014)

We just got King Vision Video Laryngoscopes for our rigs and I was wanting to pick the brains of those already using it.

1. What case/bag are you currently using to store/transport the unit and blades in?

2. Which blade (channeled vs regular) have you had the most success with?

3. Any tricks of the trade in regards to this piece of equipment would be great.

I appreciate your feedback.


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## TransportJockey (Jun 29, 2014)

ABQmedic said:


> We just got King Vision Video Laryngoscopes for our rigs and I was wanting to pick the brains of those already using it.
> 
> 1. What case/bag are you currently using to store/transport the unit and blades in?
> 
> ...



Wow someone in the metro actually bought a VL set? Nice. I tend to use the channeled blades at work the most, and I'm averaging 3-5 tubes a week (168 hours on, 168 hours off) with it. Just make sure the tip of hte blade has some lube on it. As for what we store it... it's actually a sz 3 channeled and sz 3 unchanneled in a pocket of our Stat Packs, with the video portion in its carrying case it came with


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## 46Young (Jun 29, 2014)

Channeled blade with a bougie, every time. Hold the blade softly, release your pinky finger to keep your grip delicate. Go straight in - it's not a sweep like the Mac. When you see the cords, back off a little, and the bougie will line up properly. Fold the bougie once around to give it some curve before inserting along the channel. Hold the bougie closer to the mouth, not near the top of the blade. Use an "intubation pillow" (a folded towel) under the head to place the pt in sniffing position, and use cricoid pressure if needed.  

The only problem I've ran into so far is the screen fogging up due to condensation.


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## FiremanMike (Jun 29, 2014)

ABQmedic said:


> We just got King Vision Video Laryngoscopes for our rigs and I was wanting to pick the brains of those already using it.
> 
> 1. What case/bag are you currently using to store/transport the unit and blades in?
> 
> ...



1.  We just use the little rubber case that it came with, toss it and some blades into a bigger kit with our airway stuff and drugs.

2.  I tried to get the non channeled blades so that we could have options but no one else liked them.  We use the channeled blade exclusively.  Remember that the non channeled blade technique is different than the channeled and most closely resembles the technique of the glidescope.  IMHO if you go with the non channeled blades, try to snag some of those rigid glide scope stylets.  There is a repeatable technique that can be used to form a disposable stylet into a usable shape, but it's not ideal.

3a.  Keep some surgilube packets in with your king vision and put just a dab on your tube before you load it into the channel (disregard if you go with non channeled).  

3b.  If you notice the screen freeze up or become garbled, don't panic.  All this means is that the connection between the blade and the screen came loose, the only way to fix it is to power it down, reattach the screen to the blade, and turn it back on.

3c.  Stylets are not necessary with the channeled blade.  The bougie is an interesting idea, and I may try it, but I'm curious if it's really necessary.  

3d.  If you're having trouble getting the tube to pass and it continues to go into the esophagus, it probably means you have the blade in too deep.  Back out a bit and try again, or I suppose cramming a bougie through the tube would also work.


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## NomadicMedic (Jun 29, 2014)

We are adding King vision to our equipment load out in July. We plan on using channeled blades exclusively, without a bougie.

We will carry the video screen and extra batteries in the small case and two blades in a side pocket in a Statpack.


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## Carlos Danger (Jun 29, 2014)

46Young said:


> Channeled blade *with a bougie, every time*. Hold the blade softly, release your pinky finger to keep your grip delicate.



Why a bougie every time?


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## NomadicMedic (Jun 29, 2014)

Remi said:


> Why a bougie every time?




With DL I use a bougie every time. I don't see the need with VL though.


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## Carlos Danger (Jun 29, 2014)

DEmedic said:


> With DL I use a bougie every time. I don't see the need with VL though.



Just curious why you use it every time?


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## NomadicMedic (Jun 29, 2014)

I've found that for the small number of tubes I place every year, right around 10, the bougie gives me a better opportunity for first pass success. Even if I'm looking a airway where I can't visualize the glottic opening, the bougie will still pass. It's become a habit and rather than go to it as an adjunct for my second try, it's right there on the first go around. I saw a study a while back (don't have the citation at the moment) that a bougie greatly improved first pass success rates and I took it to heart.


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## TransportJockey (Jun 29, 2014)

DEmedic said:


> I've found that for the small number of tubes I place every year, right around 10, the bougie gives me a better opportunity for first pass success. Even if I'm looking a airway where I can't visualize the glottic opening, the bougie will still pass. It's become a habit and rather than go to it as an adjunct for my second try, it's right there on the first go around. I saw a study a while back (don't have the citation at the moment) that a bougie greatly improved first pass success rates and I took it to heart.


My old service in NM required bougies on every tube for that very reason.


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## NomadicMedic (Jun 29, 2014)

Back to the King vision, I expect our department SOP to change, as well. I foresee a 2 attempt max, using VL, then directly on to a rescue airway or cric.


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## 46Young (Jun 29, 2014)

Remi said:


> Why a bougie every time?



Some providers have had trouble lining up the tube with the cords when using the channeled blade, despite seeing the cords. When you bend the bougie before inserting, and also using the fact that the tip faces anterior, it just lines up better than just using the tube. The time spent passing the tube over the bougie is the same as, or less than the time it would take a provider to play with the angle and depth of the blade to get the tube to line up right, and not be posterior.

Edit: Also, in general when using the bougie, you can get confirmationby feeling it "click" as it passes down the trachea, although this is not an absolute. What I've found to be true is that if you have proper placement, the bougie should stop advancing at the carina, but if it's in the esophagus, you can keep advancing it.


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## ABQmedic (Jun 30, 2014)

*Thanks*

Thanks for the replies.  In practice, I have found the bougie to be a great tool with both blades.  We currently use a Contera Infintiy Jump bag, so I plan on ordering a velcro bag to hold the King Vision.  I just wanted to pick the brains of those who already use it in the field (no sense re-inventing the wheel).


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## Carlos Danger (Jun 30, 2014)

DEmedic said:


> I've found that for the small number of tubes I place every year, right around 10, the bougie gives me a better opportunity for first pass success. Even if I'm looking a airway where I can't visualize the glottic opening, the bougie will still pass. *It's become a habit and rather than go to it as an adjunct for my second try, it's right there on the first go around*. I saw a study a while back (don't have the citation at the moment) that a bougie greatly improved first pass success rates and I took it to heart.



I like that approach.


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## NomadicMedic (Jun 30, 2014)

These days I'm a lot less cavalier about airway management.


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## Carlos Danger (Jun 30, 2014)

DEmedic said:


> These days I'm a lot less cavalier about airway management.



So am I. The more experience I gain, the more conservative I become.


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## FiremanMike (Jul 1, 2014)

TransportJockey said:


> Wow someone in the metro actually bought a VL set? Nice. I tend to use the channeled blades at work the most, and I'm averaging 3-5 tubes a week (168 hours on, 168 hours off) with it. Just make sure the tip of hte blade has some lube on it. As for what we store it... it's actually a sz 3 channeled and sz 3 unchanneled in a pocket of our Stat Packs, with the video portion in its carrying case it came with



I gotta ask, what job are you doing that you average 3-5 tubes a week?


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## TransportJockey (Jul 1, 2014)

FiremanMike said:


> I gotta ask, what job are you doing that you average 3-5 tubes a week?


Rural ground 911 and flight. Long transports, lots of trauma and codes. Plus aggressive RSI protocols on top of it. I'm one of two als trucks covering over 3k square miles of coverage area, with the most oil rigs in the state of texas per county. Plus I'm on acweek, off a week.


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## FiremanMike (Jul 1, 2014)

TransportJockey said:


> Rural ground 911 and flight. Long transports, lots of trauma and codes. Plus aggressive RSI protocols on top of it. I'm one of two als trucks covering over 3k square miles of coverage area, with the most oil rigs in the state of texas per county. Plus I'm on acweek, off a week.



Sounds like fun!


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## TransportJockey (Jul 1, 2014)

FiremanMike said:


> Sounds like fun!


It is  I love my job


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## SandpitMedic (Aug 30, 2014)

Used the KV for the first time on a patient. 

Must say... Super freakin cool.


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## Handsome Robb (Aug 30, 2014)

Wait...y'all have KVs down there!?!?

I love how it's the same state but for all intents and purposes two different states when it comes to our EMS system.


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## SandpitMedic (Sep 1, 2014)

Yeah. It's strange. We operate under SOUTHERN Nevada Health District. Kind of weird how they split it like that. What's your certifying agency?

And yes we got them about 2 weeks ago.


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## chaz90 (Sep 2, 2014)

I am having a terrible time with the King Vision on real patients! I expected it to be a huge help, but I simply can't seem to get the distal end of the ETT anterior enough using the channeled blade. View hasn't been a problem, but I haven't been able to direct the tube itself where I want it at all. I realize you sometimes have to pull out slightly more than anticipated due to where the tube is vs. the camera lens, but this still hasn't helped.

Has anyone else had problems like this? I'm open to all suggestions.


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## TransportJockey (Sep 2, 2014)

The channeled blades don't work well with tubes over 7.0 really. You need to lube the distal end very well. I usually have better luck with channeled and a bougie than channeled ans a tube


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