1. Sierra – Sacramento Valley EMS Agency
EMT King LT-D Airway Device Optional Skill
(Updated 06/2017)

2. In order for EMT personnel to utilize a King LT-D airway device, they must:
Be part of the organized EMS system, functioning under the oversight of an S-SV EMS approved BLS optional skills provider
Be authorized by the approved BLS optional skills provider to utilize the King LT-D airway device
Have received adequate training on the utilization of the King LT-D airway device

3. Education/Training Purpose and Objectives
To enable authorized EMT personnel to utilize the King LT-D airway device in the prehospital setting
Objectives – describe/demonstrate
Advantages and disadvantages of utilizing the King LT-D
Indications and contraindications for utilizing the King LT-D
Components and sizing of the King LT-D
Placement and confirmation procedures for the King LT-D
Tips, troubleshooting and removal steps for the King LT-D

4. King LT-D Advantages Disadvantages Indications Contraindications
Design/Components
Sizing Information

5. King LT-D Overview King LT-D Advantages
Smaller than other devices (e.g., Combitube)
More cost-effective than other options
Easier/quicker to place (single port, single tube)
Does not require interruption of CPR during placement
Little or no spinal movement during placement
Provides a means for positive pressure ventilation
Minimizes gastric insufflation
Available in multiple sizes based on patient size

6. King LT-D Overview King LT-D Disadvantages
Patient must be unresponsive with no gag reflex
Still a risk of aspiration
May decrease cerebral blood flow

7. King LT-D Overview King LT-D Indications
Cardiac arrest
Respiratory arrest or severe compromise and unable to adequately ventilate with BVM
King LT-D Relative Indications
Sustained altered mental status with a GCS ≤ 8
Impending airway edema in the setting of respiratory tract burns or anaphylaxis

8. King LT-D Overview King LT-D Contraindications
Patients under 4 feet tall
Responsive patient with intact gag reflex
Patients with known esophageal disease (esophageal varices, etc.)
Patients who have ingested a caustic substance

9. King LT-D design/components
King LT-D Overview
King LT-D design/components

10. King LT-D Overview King LT-D design/ components
Plastic wrapped package includes:
King LT-D airway
60 mL syringe
Water soluble lubricating jelly

11. King LT-D Overview King LT-D design/components
Imprinted on the side of the airway you will find:
Airway size
Depth markings in cm
How many mls of air required to properly inflate cuffs

12. King LT-D Overview King LT-D design/ components
The primary ventilation opening is located just below the proximal cuff
Additional ventilation holes are located on each side of the primary ventilation opening

13. King LT-D Overview
King LT-D sizing

14. King LT-D Insertion Procedure Confirmation Procedure Tips
Troubleshooting
Removal
Additional Requirements

15. King LT-D Insertion Procedure
Ensure adequate BLS airway
Choose correct size King LT-D airway
Pre-oxygenate patient
Provide BVM ventilation with 100% O2
May also apply/utilize a nasal cannula with high flow O2 for the duration of the procedure if an additional O2 source is available

16. King LT-D Insertion Procedure
Test cuffs for air leak
Draw correct amount of air into packaged 60 mL syringe
Attach syringe to the cuff port valve and fully inflate
Detach syringe and check cuff for leaks
Deflate cuffs

17. King LT-D Insertion Procedure
Position the head
“Sniffing position” is ideal
A neutral position can also be used if trauma is suspected
Perform a chin lift
Use caution on patients requiring c- spine precautions

18. King LT-D Insertion Procedure
Lubricate distal end of airway with water soluble jelly
Avoid introduction of lubricant in or near the ventilatory openings

19. King LT-D Insertion Procedure
Apply the airway
Introduce tip into mouth
Advance tip behind base of the tongue while rotating tube back into midline
Blue orientation line imprinted on tube should face the patient’s chin

20. King LT-D Insertion Procedure
Apply the airway (cont.)
Without exerting excess force, advance tube until base of connector is aligned with teeth or gums

21. King LT-D Insertion Procedure
Apply the airway (cont.)
Inflate cuff with initial amount of air
Size 3 = 50 ml
Size 4 = 70 ml
Size 5 = 80 ml
Important – Remove syringe from inflation port immediately after inflation

22. King LT-D Insertion Procedure
Apply the airway (cont.)
Attach BVM and ventilate
Slowly withdraw the device until ventilation is easy and free flowing
Minimal retraction is usually needed to achieve the best air flow – if significant resistance to flow is met after retraction, it is likely that the device is not in the correct position and should be removed

23. King LT-D Insertion Procedure
Apply the airway (cont.)
Correct airway placement must be confirmed utilizing all of the following:
Chest rise and fall
Presence of lung sounds
Absence of epigastric sounds
ETCO2 detector color change

24. King LT-D Insertion Procedure
Secure/maintain device
Consider securing with tape or commercial ET tube holder
Securing with tape or ET tube holder not required, but recommended
With cuffs inflated device tends to fit snugly and securely

25. King LT-D Insertion Procedure
King LT-D proper placement

26. King LT-D Insertion Tips
Tips for successful insertion
Utilize midline approach:
Perform a chin lift and slide the distal tip along the palate and into position in the hypopharynx
If tip is placed laterally, it may enter the piriform fossa and the tube will bounce back upon full insertion and release
Keeping the tip at the midline assures that the distal tip is properly placed in the hypopharynx/upper esophagus
Ensure proper insertion depth:
Ventilatory openings of the King LT-D must align with the laryngeal inlet for adequate oxygenation/ventilation

27. King LT-D Insertion Tips
Tips for successful insertion (cont.)
Ensure cuffs are properly inflated:
Be prepared to re-inflate cuffs with another 10 mL of air in the event of air leakage
Do not over inflate cuffs – use the minimum volume of air necessary to seal the airway
Avoid damage to the King LT-D:
Use caution - cuffs can be damaged by broken teeth/dentures
Remove dentures prior to placing device if applicable

28. King LT-D Insertion Tips
Tips for successful insertion (cont.)
Avoid airway trauma:
Do not force device while inserting as airway damage may occur
Reassess/adjust as needed:
During spontaneous breathing, the epiglottis or other tissue can be drawn into the ventilatory openings, resulting in obstruction – advancing the device 1 – 2 cm normally eliminate this obstruction

29. King LT-D Troubleshooting
Utilize proper placement procedures
To avoid tracheal placement, maintain head in a neutral position
Ventilation will not occur if placed in the trachea
Most unsuccessful placements result from failure to keep tube in midline during placement
If unable to ventilate – remove device and replace
If unsuccessful on second attempt, BLS airway management should be resumed

30. King LT-D Removal Removal steps
Once in place, the King LT-D should only be removed in the prehospital setting if absolutely necessary (patient regains consciousness, unable to ventilate, etc.)
Suction above cuff in the oral cavity if needed
Fully deflate cuffs
Remove the device
Reassess the patient and continue to appropriately manage the airway

31. King LT-D Utilization Additional Requirements
Other responsibilities
Inform other appropriate EMS providers and/or the receiving hospital of any pertinent details related to the utilization of the King LT-D
Adequately document the utilization of the King LT-D for reporting and QI review requirements