King VS ET

NPO

NPO

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On a recent cardiac arrest my partner (medic) and I (basic) were working in the back while a third EMT drove. Fire had swapped me out for compressions already so I was bagging. He was quite busy establishing access (failed IV to no fault of his, attempting manual IO). All I'm doing is squeezing a bag every few seconds. Thinking I can do more I offer to place a king as all the patient had was an OPA. The OPA was working, and there was very little resistance on respirations, but I thought he might like a secure airway when we roll into the er a few minutes away. He told me that when there is a medic on scene EMTs aren't supposed to place kings.

I understand wanting the more senior person (and higher level of care) to place the airway, but in the interest of time, I feel like it should be okay to delegate a task to someone who is capable of doing it within there scope. The policy seems to be because the ems dept prefers ET over King, since that is how the paramedic protocol reads.

Now, me being a Basic, I don't have a lot of ET training outside of working with medics and a few intubations on dummy heads. Can someone explain the benefits of an ET over a King to me? Am I wrong in thinking it should be okay to delegate that task if the medic so chooses and the king is within the basic's scope, in which case it is for me.
 
Theoretically, the ET tube protects against aspiration of emesis or secretions into the lungs, whereas a King does not actually guarantee that.

That is, however, in a perfect world.
 
^ correct. Also it depends on which medic you work with.
 
NPO said:
On a recent cardiac arrest my partner (medic) and I (basic) were working in the back while a third EMT drove. Fire had swapped me out for compressions already so I was bagging. He was quite busy establishing access (failed IV to no fault of his, attempting manual IO). All I'm doing is squeezing a bag every few seconds. Thinking I can do more I offer to place a king as all the patient had was an OPA. The OPA was working, and there was very little resistance on respirations, but I thought he might like a secure airway when we roll into the er a few minutes away. He told me that when there is a medic on scene EMTs aren't supposed to place kings.

I understand wanting the more senior person (and higher level of care) to place the airway, but in the interest of time, I feel like it should be okay to delegate a task to someone who is capable of doing it within there scope. The policy seems to be because the ems dept prefers ET over King, since that is how the paramedic protocol reads.

Now, me being a Basic, I don't have a lot of ET training outside of working with medics and a few intubations on dummy heads. Can someone explain the benefits of an ET over a King to me? Am I wrong in thinking it should be okay to delegate that task if the medic so chooses and the king is within the basic's scope, in which case it is for me.
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kindofafireguy said:
Theoretically, the ET tube protects against aspiration of emesis or secretions into the lungs, whereas a King does not actually guarantee that.

That is, however, in a perfect world.
Click to expand...

TRSpeed said:
^ correct. Also it depends on which medic you work with.
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Good news, in this case none of that mattered. Transporting a patient with ongoing CPR is far more likely to result in a bad outcome than the selection of your airway device!

The available retrospective research even shows that your OPA+BVM is the better choice over both ETT or a SGA. ETT's probably confer a minor benefit in patients who receive longer resuscitation, but that's not really known. As far as aspiration concerns...the vast majority of patients who aspirate during cardiac arrest do so prior to EMS arrival.

The really killer in cardiac arrest is inadequate chest compressions.

Fiddling with an airway? If it isn't a respiratory etiology that'll kill the patient if it gets in the way of chest compressions. My EMT's frequently place King's for me during cardiac arrests. I could care less what they do as long as somebody is pumping on the chest.

Moving the patient? If they don't have a pulse, the number of times this will need to happen should be countable on one hand (with one finger perhaps).

IV/IO? Who cares, the drugs don't seem to work anyways...just don't stop CPR :)

Defibrillation? Very important. Mas importante. Be sure to do picture perfect chest compressions up until the point of defib, minimize the perishock pause (we're talking sub 10 seconds, sub 5 is preferable), and don't delay defibrillation for anything other than chest compressions.

tl;dr: the choice in airway is irrelevant if you do not work cardiac arrests on scene.
 
NPO said:
On a recent cardiac arrest my partner (medic) and I (basic) were working in the back while a third EMT drove. Fire had swapped me out for compressions already so I was bagging. He was quite busy establishing access (failed IV to no fault of his, attempting manual IO). All I'm doing is squeezing a bag every few seconds. Thinking I can do more I offer to place a king as all the patient had was an OPA. The OPA was working, and there was very little resistance on respirations, but I thought he might like a secure airway when we roll into the er a few minutes away. He told me that when there is a medic on scene EMTs aren't supposed to place kings.

I understand wanting the more senior person (and higher level of care) to place the airway, but in the interest of time, I feel like it should be okay to delegate a task to someone who is capable of doing it within there scope. The policy seems to be because the ems dept prefers ET over King, since that is how the paramedic protocol reads.

Now, me being a Basic, I don't have a lot of ET training outside of working with medics and a few intubations on dummy heads. Can someone explain the benefits of an ET over a King to me? Am I wrong in thinking it should be okay to delegate that task if the medic so chooses and the king is within the basic's scope, in which case it is for me.
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If you don't mind me asking, what county do you work for? I thought my system was top notch in terms of SOP for basics. Placing an ET or King is out of scope and would definitely get you in hot water. Good conversational piece nonetheless.
 
BASICallyEMT said:
If you don't mind me asking, what county do you work for? I thought my system was top notch in terms of SOP for basics. Placing an ET or King is out of scope and would definitely get you in hot water. Good conversational piece nonetheless.
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Kern County CA. We have an optional expanded scope to include King LT-D
 
BASICallyEMT said:
If you don't mind me asking, what county do you work for? I thought my system was top notch in terms of SOP for basics. Placing an ET or King is out of scope and would definitely get you in hot water. Good conversational piece nonetheless.
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In regards to EMS in SoCal, the words top notch and California are ones that should never go together..... Unless the word "not" is in there.
 
There is room for improvement up here, but I have to say, Kern County is one of the best systems I've seen. Not just talking about protocols but hospital relations, fire relations, response times, etc. Im happy to work in this system as opposed to my old system in Los Angeles...
 
BASICallyEMT said:
If you don't mind me asking, what county do you work for? I thought my system was top notch in terms of SOP for basics. Placing an ET or King is out of scope and would definitely get you in hot water. Good conversational piece nonetheless.
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i worked Riv for a a couple of yrs, before coming over to Hall in Kern. I can say Riv is a good place too(especially compared to LA,OC) especially with the new med director but still far below kern co in more ways than I can count in 2 hands.

Just don't get complacent , as an emt and a employee I know moral sucks there right now. In Ric Co Bls units don't run 911 so they don't get much exp other than the occasional SNF to ER. And even those the hospitals will throw a fit if their is even a remote chance they could be ALS.



NPO said:
There is room for improvement up here, but I have to say, Kern County is one of the best systems I've seen. Not just talking about protocols but hospital relations, fire relations, response times, etc. Im happy to work in this system as opposed to my old system in Los Angeles...
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Don't forget , bls fire, priority dispatching including bls ambulance response, scene control, etc ;)
 
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DesertEMT66 said:
In regards to EMS in SoCal, the words top notch and California are ones that should never go together..... Unless the word "not" is in there.
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That is a good point. But, referring to Socal I think we are pretty progressive.
 
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TRSpeed said:
i worked Riv for a a couple of yrs, before coming over to Hall in Kern. I can say Riv is a good place too(especially compared to LA,OC) especially with the new med director but still far below kern co in more ways than I can count in 2 hands.

Just don't get complacent , as an emt and a employee I know moral sucks there right now. Bls units don't run 911 so they don't get much exp other than the occasional SNF to ER. And even those the hospitals will throw a fit if their is even a remote chance they could be ALS.





Don't forget , bls fire, priority dispatching including bls ambulance response, scene control, etc ;)
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I currently work in Riv County and I completely agree with you.
 
TRSpeed said:
Come over to Hall. If you want a career in EMS.
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^ This. We run the show. Fire walks up and ask US what WE need. I'm not against fire helping out, and sometimes we definiately need it. But its a whole let better working WITH them rather than FOR them like I'm used to.
 
Back to the original question, ET has the benefit of not putting possible pressure on arteries/vein in the neck in the event of swelling, whereas a King tube could cut off blood flow to the brain.
 
Quikclot said:
Back to the original question, ET has the benefit of not putting possible pressure on arteries/vein in the neck in the event of swelling, whereas a King tube could cut off blood flow to the brain.
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This has never been proven in humans, and I'm highly skeptical that it ever will be. Millions of patients a year undergo elective surgery with LMA's in place, and no increase in morbidity or mortality has ever been identified as a result.

Unfortunately, the many people who still insist that "real paramedics intubate" use this purely hypothetical idea to support outdated practice.
 
A local agency did a small study* using fresh cadavers to see if it truly does impede circulation. Many providers down here were (incorrectly so) taught to inflate the balloon until they got some back pressure. They found that there was impedance when the balloon was inflated in that manner (I forget what the average amount of air that came out to was- I believe it was around 100mL). However, they found no evidence of this when the balloon was inflated to the manufacturer's recommendations.

The LMA in the hospital argument is invalid, though. That's an entirely different device from the King tube, and nobody has ever said the LMA causes vascular occlusion.

*They used four different cadavers I believe, and I'm not sure if they are going to get it published since it was so small of a sample.
 
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NPO said:
On a recent cardiac arrest my partner (medic) and I (basic) were working in the back while a third EMT drove. Fire had swapped me out for compressions already so I was bagging. He was quite busy establishing access (failed IV to no fault of his, attempting manual IO). All I'm doing is squeezing a bag every few seconds. Thinking I can do more I offer to place a king as all the patient had was an OPA. The OPA was working, and there was very little resistance on respirations, but I thought he might like a secure airway when we roll into the er a few minutes away. He told me that when there is a medic on scene EMTs aren't supposed to place kings.

I understand wanting the more senior person (and higher level of care) to place the airway, but in the interest of time, I feel like it should be okay to delegate a task to someone who is capable of doing it within there scope. The policy seems to be because the ems dept prefers ET over King, since that is how the paramedic protocol reads.

Now, me being a Basic, I don't have a lot of ET training outside of working with medics and a few intubations on dummy heads. Can someone explain the benefits of an ET over a King to me? Am I wrong in thinking it should be okay to delegate that task if the medic so chooses and the king is within the basic's scope, in which case it is for me.
Click to expand...

Studies have shown that all you need is an airway. That's it. Nothing more. OPA, SGA, ETT, it doesn't matter. You can't kill a dead man.

Just treat chest compressions like Pringles: once you pop, you just can't stop.
 
Thanks everyone. Lots of useful information
 
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