Self-learning Module Practical Review King LTS-D Airway Self-learning Module Practical Review Maryland ExpressCare_2009
Maryland ExpressCare_2009 Objectives Identify anatomy of the upper airway. Describe current artificial airways. Describe the indications and contraindications for the placement of the King LTS- D airway (KLTS-D). Describe the correct placement of the KLTS-D. Describe MIEMSS Laryngeal Tube Airway Device protocol. Demonstrate the correct placement of the KLTS-D. Demonstrate troubleshooting techniques Maryland ExpressCare_2009
Maryland ExpressCare_2009 Contents Section 1 – Upper Airway Anatomy & Artificial Airway Options Review Section 2 – King LTS-D introduction/use. Section 3 – MIEMSS protocol review Section 4 – Post Test Maryland ExpressCare_2009
Maryland ExpressCare_2009 Instructions Review power point, click on and read/view all links. Record answers to post-test questions at end of Self-Learning Module on separate Post-test and Practical Experience Confirmation form. Take form with recorded answers to evaluator; perform practical experience with evaluator. Maryland ExpressCare_2009
Review of Artificial Airway Options SECTION 1 Upper Airway Anatomy & Review of Artificial Airway Options Maryland ExpressCare_2009
Maryland ExpressCare_2009 Upper Airway Anatomy Maryland ExpressCare_2009
Common Non-surgical Artificial Airways Maryland ExpressCare_2009
Oral Airway Nasal Airway Oral airway placed into the oropharynx Nasal Airway placed into the nasopharynx Maryland ExpressCare_2009
Maryland ExpressCare_2009 Combitube Maryland ExpressCare_2009
Endotracheal intubation Maryland ExpressCare_2009
LMA-Laryngeal Mask Airway Maryland ExpressCare_2009
Maryland ExpressCare_2009 King LTS-D Maryland ExpressCare_2009
Maryland ExpressCare_2009 Section 2 King LTS-D Introduction Placement Use Contraindications/Warnings Maryland ExpressCare_2009
King LTS-D Description King LTS-D consists of a curved double-lumen tube with separate pathways for ventilation/access to stomach Ventilation lumen- ends between two inflatable cuffs with a variety of openings to align with the laryngeal inlet Has a 15 mm connector for attachment to resuscitation bag or ventilator circuit Gastric lumen- Separate conduit which will allow passage of up to 18 Fr standard gastric tube Maryland ExpressCare_2009
King LTS-D Indications for use This device (per MIEMSS protocols) is intended for: Patients requiring an artificial airway who have failed direct laryngoscopy without a gag reflex Maryland ExpressCare_2009
Maryland ExpressCare_2009 King LTS-D Benefits Latex Free Provides the ability to provide positive pressure ventilation as well as allowing spontaneous breathing Seal Pressure > 30 cm H20 Ease of Insertion Low incidence of sore throat/trauma Minimizes gastric insufflation Allows for easy passing of a gastric tube via the gastric access lumen Maryland ExpressCare_2009
King LTS-D Warnings/Precautions Not proven to protect the airway from the effects of regurgitation/aspiration High airway pressures may divert gas to the atmosphere Intubation of the trachea cannot be ruled out as a potential complication After placement, perform standard checks for breath sounds/utilize appropriate CO2 Lubricate only the posterior surface of the King LTS-D to avoid blockage of the ventilation apertures or aspiration of lubricant Single use only Maryland ExpressCare_2009
King LTS-D Contraindications Responsive patients with an intact gag reflex Patients with known esophageal disease Patients who have ingested caustic substances Patients < 35 inches (per MIEMSS protocols) Maryland ExpressCare_2009
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Maryland ExpressCare_2009 King LTS-D Research Click links to read articles http://www.emsresponder.com/print/EMS-Magazine/Prehospital-Pediatric-Airway-Management/1$8905 http://www.kingsystems.com/Portals/1/The%20use%20of%20the%20laryngeal%20tube%20by%20nurses%20in%20out%20of%20hospital.pdf http://www.kingsystems.com/Portals/1/Guyette,%20KING%20Airway%20Use%20by%20Air%20Medical%20Providers.pdf http://www.kingsystems.com/Portals/1/Airway%20management%20in%20cardiac%20arrest.pdf http://www.kingsystems.com/Portals/1/A%20new%20adjunct.pdf http://www.jems.com/news_and_articles/columns/Wesley/Three_Airway_Modalities_in_Difficult_Airways.html# Manufacturer Instructions Link: http://www.kingsystems.com/Portals/1/KING%20LT(S)D%20IFU%200608.pdf Videos: http://www.kingsystems.com/portals/1/king%20lt%20web.wmv http://www.youtube.com/watch?v=ryyHWewl5ho Maryland ExpressCare_2009
Maryland ExpressCare_2009 King LTS-D Insertion Maryland ExpressCare_2009
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King LTS-D Additionally Insertion of a nasogastric tube (up to 18 Fr) thru the proximal opening of gastric access lumen will: Ensure proper placement Allow stomach to decompress Maryland ExpressCare_2009
Section 3 – MIEMSS optional protocol review Maryland ExpressCare_2009
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Maryland ExpressCare_2009 Post – Test questions Place the answers to the following questions on the separate Post – Test and Practical Experience Verification form. Maryland ExpressCare_2009
Maryland ExpressCare_2009 1.The proper size King LTS-D tube for a 5’8” patient is : a. 3 b. 4 c. 5 d. 6 2.When initially inserting the LTS-D into the mouth the blue orientation line should be facing the patient’s_________ . a. chin b. corner of mouth c. septum d. tongue 3. The proper size King LTS-D tube for a 6’2” patient is : Maryland ExpressCare_2009
Maryland ExpressCare_2009 4. An 18 Fr or smaller NG tube can be placed thru the proximal gastric opening of the LTS-D tube into the esophagus and stomach? a. TRUE b. FALSE 5. After insertion of the LTS-D tube and inflation of the cuffs, withdrawing the tube slightly while ventilating may be required to achieve better ventilation. 6.In Maryland, a size 2 or 2.5 LTS-D tube can be used for a pediatric patient according to their height. Maryland ExpressCare_2009
Maryland ExpressCare_2009 7. Heavy insertion force is sometimes required to get the LTS-D tube into proper position prior to inflating the cuffs : a. TRUE b. FALSE 8. The proper cuff inflation volume for a 4’6” patient should be about : a. 60 ml b. 70 ml c. 80 ml d. 90 ml 9. The King LT-D and the King LTS-D are essentially the same and either can be used in Maryland : Maryland ExpressCare_2009
Maryland ExpressCare_2009 10. The blue orientation line of the tube should be rotated to face the patient’s chin after the distal tip of the tube passes _______ . a. the teeth b. into the esophagus c. the base of the tongue d. the epiglottis POST TEST COMPLETE Maryland ExpressCare_2009
Maryland ExpressCare_2009 Conclusion Please turn in your answers to an approved evaluator and complete the practical experience to finalize this training. Maryland ExpressCare_2009