King LT Airway
 

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Too good to be true?

Many EMS services in Wisconsin use a similar dual-lumen airway called the combi-tube which has been around for quite a few years. Apologies in advance if you already know of this. Some services in Wisconsin that are not at the Paramedic level are allowed to be trained to do endotracheal intubations in the field per their medical directors. However, those that are not still need the capability of a more advanced airway than a nasal or oralpharyngeal airway, hence the combi-tube. It is a blind insertion requiring no laryngoscope and is designed to be inserted into the esophagus. Also where the ET intubated patient was most likely supine or possibly in the sitting position (if the individual intubating is experienced) the combi-tube is postion independent due to its blind insertion. If the tube is inserted and gastric sounds are heard upon ventilation using lumen #1 or gastric distension is observed you simply switch to the #2 lumen and try again. Generally this means that rather than going into the esophagus the combtube went into the trachea and can be used as an edotracheal tube including drugs down the tube (if an IV has not been achieved) or a suction catheter down the tube. However, it is a large bulky tube and can and has caused more damage to the patient when being inserted. If the tube is inserted too deeply or not deep enough it will not work. When inserted properly, drugs or suction CANNOT go down the tube because there is no direct path to reach the lungs or trachea. Also if there is massive displacement of the airway for example an unsuccesful attempted suicide by shotgun to the mouth ( i've seen this one) with massive displacement of the maxila and mandible and exposed vocal chords, there is no way in hell you can get that big-ass tube in there to secure that airway. We just used a smaller cuffed ET tube, stuck it in the trachea that we could see, secured it the best we could and loaded him onto the helo. Basically I believe their advertisement is correct in that it is an effective alternative until normal ET intubation can be achieved. It is not a fail-safe airway by any means, just another option at your disposal.


Some sources of info: Mosby's EMT-Intermediate Textbook 1997 edition
Mosby's PHTLS textbook 5th edition 2003
Combi-tube website?

Just for info I am not a paramedic but am trained to do ET intubations per my medical director.


smokfire

The only problem I see with it is the need to disrupt ventilations to remove it from the patient when the time comes to introduce an ETT.

Here, well where I used to work, LMA's are used for those individuals needing an airway where an ETT could not be acheived at that time for whatever reason. After insertion an ETT can be introduced without the previously mentioned problem.

Here is a link to their site.

What the hell Smokfire? You guys still use a combi-tube?

Crip

but the LMA is not cuffed like ET and combitube. and it is the only bad thing to say on the LMA

Frank

The LMA has a cuff at the distal end.

I never saw, much less used a LMA until I did my OR rotation. It was not in the protocols, so they weren't in the trucks. We had combi-tubes. Still have MAST pants though. :rolleyes:

yes but it dont stop aspiration, like Et only seal fore esay vent.

Frank

It is more of a tiertiary device here for the Medics in most cases. We rarely use it without trying an ETT first, but I know of several places that use them for EMT-Basics where the MD wont let them ETT someone. Just does not make sense to me why EMT's cant tube. Only 1 medic in our county has used one and that was after he RSI'd a guy and could not get him tubed. Patient had some strange anatomy I was told. At any rate they are fairly easy to use from what I have seen/been told. Damn MAST Pants.



At any rate, I have drug us off topic again. So NDD, what do you think of the KING LT Airway adjunct?

Crip

What the hell Smokfire? You guys still use a combi-tube?


Do we use them? If at all possible hell no! However the state of Wisconsin requires us by law to carry them on the trucks because there are still some basic and intermediate squads that are not allowed to do ETI. Although i'd rather have one of these instead of an oral or nasal to secure an airway in a pinch! Just my .02.

Hope training is going well for you. Glad to hear you were selected.

smokfire

Oh how I wish. Not yet, but in time.

In my somewhat limited experience i have found that LMAs dont fit all patient because of their anatomy. I still belive that the combitube is a great choise for military medics that do few intubations in OR or in the real world.

My apologies, thought I had read that you had been. In due time my friend, in due time.


I would like to request the opinion of the QP or BTDTs. Any of you used these or something like it while in training or deployed?

In my deployment bag i have the following airway supplies:
Nasal airways 28 and 32
Some oral airways
Complete intubation kit
Two LMA large adult and adult
Combitubes are not issue in Swedens Armed Forces

still beter then the danish army, we have only ET and oral airways.