King vs. Intubation

[DrankTheKoolaid]

Careful there. If there is reason to believe that the BLS airway is causing the airway nightmare pulling it can be the right thing to do.

Yeah I actually thought that was obvious. If an airway is not patent with a BLS/SGA in place it gets pulled as it is not doing any good anyways and most likely was hastily placed and not sized correctly.

I was actually speaking about anatomical airway nightmares.

 

[LearningByMistakes]

Obviously you did not read my post Corky.

And are you questioning my ability to handle an airway?

Christopher, well said.

 

[DrankTheKoolaid]

re

?, I am not singling any provider out. Everyone knows there own competence level and should not go beyond it. If any of my posts were mistakenly taken that way, it was done in error.

 

[LearningByMistakes]

No problem then Corky, fair enough.

 

[DrankTheKoolaid]

Their, There, They're

I really hate when I miss that after the edit timer expires

 

[LearningByMistakes]

LOL! Welcome to MY world Corky!

 

[MSDeltaFlt]

What is an "airway"? Definition: an unobstructed path between the oxygen source and the lungs. Period. Without question.

And what does A.H.A. suggest should be done for advanced airway placement during cardiopulmonary arrest situations? Simple. Don't stop compressions. What if the airway is a Grade 4? Don't stop compressions.

So what should be done when a higher level of care arrives on scene?

1. Breathe. Even if your pt isn't, you make d@MN sure you do.

2. Never say never. Never say always.

3. Assess the situation: history of the call and especially the pt. Not merely some @#$% EtCO2. Assess the airway: patency, ventilation (breath sounds AND EtCO2).

Then do what's right.

Would I have changed the King? Depends. Depends on what I Would discover in what I typed in the above.

 

[lightsandsirens5]

Unless you are VERY comfortable with your airway management I would caution you about pulling a working airway. Ending up with a cric because you don't like supraglotic airways is poor form...

Well, usals beat me to it. As usual.

 

[Sublime]

Sorry for bringing this thread back from the dead, but I have some questions!
I'm a new primary medic at my service and in our protocols we have the option to intubate or use a king in an arrest. In a full arrest situation it says a king is preferred over ETT due to ease of placement and not having to interrupt compressions.

I know intubation is the standard in the hospital, but what advantages does it have over the king? The king occludes the esophagus and even has a gastric port so you can suction to further prevent aspiration. If there is a proper bulb seal I really don't see why it's regarded as inferior in this manner.

Obviously the ET tube is directly in the trachea and the king is a supraglottic airway, but if you're getting good chest rise and capno then what's the difference? Why would changing even be considered?

 

[Aidey]

I don't know if it was in this thread or not, but there have been concerns raised about neurological outcomes in pts who had a king placed. The current theory is that they place too much pressure on the internal carotid arteries causing decreased blood flow to the brain.

 

[Medic Tim]

Sorry for bringing this thread back from the dead, but I have some questions!
I'm a new primary medic at my service and in our protocols we have the option to intubate or use a king in an arrest. In a full arrest situation it says a king is preferred over ETT due to ease of placement and not having to interrupt compressions.

I know intubation is the standard in the hospital, but what advantages does it have over the king? The king occludes the esophagus and even has a gastric port so you can suction to further prevent aspiration. If there is a proper bulb seal I really don't see why it's regarded as inferior in this manner.

Obviously the ET tube is directly in the trachea and the king is a supraglottic airway, but if you're getting good chest rise and capno then what's the difference? Why would changing even be considered?

There is newer evidence out against the king airs showing ETI and bls airway leads to better pt outcomes in an arrest (at work on my phone so I don't have a link) and Not all of them have the port on the back for a ng/og tube.

 

[d_miracle36]

I believe that ETI is the golden standard and will remain although a bls airway may lead to better outcomes I think the outcomes are probably more provider error than it is the actual airway. Isnt the king a bls airway?

 

[VirginiaEMT]

There is newer evidence out against the king airs showing ETI and bls airway leads to better pt outcomes in an arrest (at work on my phone so I don't have a link) and Not all of them have the port on the back for a ng/og tube.

There's tons of evidence that ETI is detremental to patient outcomes after cardiac arrest. I just finished a paper on the studies for paramedic school.

 

[Aidey]

Just because ETI can be detrimental doesn't mean that a king can't be more detrimental.

 

[d_miracle36]

I love the kings and lmas. A ETT can be detrimental when compressions are interrupted and verification has failed. The patient does not care what airway is in place as long as they are getting oxygen to the brain. Proper intubation is as good as king airway placement. Failure to intubate is not what kills people its failure to ventilate. Provider preference is key. If a skilled paramedic intubates it is as good if not better than a king airway placement. The problem is that there is a lack of skilled paramedics. ETI with monitored etco2 is the same as king airway with monitored etco2.

 

[Aidey]

I love the kings and lmas. A ETT can be detrimental when compressions are interrupted and verification has failed. The patient does not care what airway is in place as long as they are getting oxygen to the brain. Proper intubation is as good as king airway placement. Failure to intubate is not what kills people its failure to ventilate. Provider preference is key. If a skilled paramedic intubates it is as good if not better than a king airway placement. The problem is that there is a lack of skilled paramedics. ETI with monitored etco2 is the same as king airway with monitored etco2.

 

[d_miracle36]

Sorry I was speaking from experience. In my opinion expired gas should be the same regardless of the device its coming from if positioned properly. I dont think there is any data showing and or proving the effectiveness of using ETCO2 with a king or lma. Is it not widely accepted to use etco2 with blind insertion devices? And if it is not accepted then how many people wrongly guide their treatment based upon those values?

 

[d_miracle36]

There is no significant difference with EtCO2 readings from supraglottic airways and ETT, when an adequate bulb seal is present. I could pull some strips, but every time I've done/seen a swap the EtCO2 remains the "same" (probably +-3mmHg, not enough to notice).

The porcine studies have some interesting A&P questions related to the carotids, but are fundamentally sound. We likely should be evaluating the appropriate cuff inflation volumes when using King's.

Recently, Dr. Fowler has alluded to ROC data showing differences in discharge with ETT vs SGA, but focusing on just that comparison is a bit unfair. Simple BVM management showed a higher survival to discharge than both ETT and SGA. If you're going to use those studies, you shouldn't be placing an airway at all

...

 

[usalsfyre]

I love the kings and lmas. A ETT can be detrimental when compressions are interrupted and verification has failed. The patient does not care what airway is in place as long as they are getting oxygen to the brain. Proper intubation is as good as king airway placement. Failure to intubate is not what kills people its failure to ventilate. Provider preference is key. If a skilled paramedic intubates it is as good if not better than a king airway placement. The problem is that there is a lack of skilled paramedics. ETI with monitored etco2 is the same as king airway with monitored etco2.

What your arguing is that poor ETI is worse than good King placement, without really addressing good ETI, or bad work with a King.

Further, recent research (ROC PRIMED) suggest that the patient DOES care how ventilations are delivered (the author I spoke with mentioned 50% worse outcomes with a King vs ETI) but we're not entirely sure why.

 

[Aidey]

The question isn't whether EtCo2 works with both ETI and Kings, the question is if they are the same. Yes, there have been studies done that show basic airway maintenance is better that either ETI or a King. Not to repeat myself, but just because ETI can be detrimental to outcomes doesn't mean the king can't be more detrimental.