1. Loudoun County EMS Council, Inc ALS Committee Revised 11/2013 1 King LT-D Airway Program

2. King LT-D Airway It is a supraglottic device Also known as a blind insertion Airway Device (BIAD) Proximal cuff blocks oropharynx Distal cuff blocks esophagus Revised 11/2013 2

3. Five Sizes 25ml-35ml 2.0 Height of 35-45 Inches 30ml-40ml 2.5 Height of 41-51 Inches 45ml-60ml 3.0 Height of 4-5 Feet 60ml-80ml 4.0 Height of 5-6 Feet 70ml-90ml 5.0 Height of > 6 Feet Colors for the King LTD do not correlate with Broselow colors. Use the LMA # for the King Airway size. 3

4. Other Accessories Proper BSI BVM Oral airway Tape Water-based lubricant Stethoscope Revised 11/2013 4 Need Picture

5. Standing Orders for King Airway insertion When the patient is pulseless and apneic When the patient does not have a gag reflex (accepts an oral airway) For ALS providers as an alternative if difficulty intubating On-Line Medical Control must be obtained for any other situation Revised 11/2013 5

6. Contraindications for the use of the King Airway Patient is ALIVE! Patient is under 35 inches Patient has a gag reflex Patient has ingested a caustic substance Revised 11/2013 6

7. Use of the King Airway When used in conjunction with AED insertion is considered following: All Shocks Completed 3 No Shocks Complicated Airway (Med-Control Only) Revised 11/2013 7

8. King Airway Insertion 1 of 7 Revised 11/2013 8 Prepare Your Equipment

9. King Airway Insertion 2 of 7 Check tube and balloon Lubricate back of tube only Revised 11/2013 9

10. King Airway Insertion 3 of 7 Pre-Oxygenate patient for at least 1 minute Place patient’s head and neck in a neutral position Remove Oropharyngeal (O.P.) Airway Grasp tongue and jaw Lift the tongue and jaw anteriorly (tongue- jaw-lift) Hold the King Airway at the connector area as you would a pencil Revised 11/2013 10 INSERTION

11. King Airway Insertion 4 of 7 Insert the tube with the blue line facing the corner of the mouth As the tube passes behind the tongue, continue to insert while rotating tube until blue line is mid line Revised 11/2013 11

12. King Airway Insertion 5 of 7 Insert the tube until the base of the connector is at the level of the teeth or gums. Inflate balloon with the appropriate amount of air based on size used. Revised 11/2013 12

13. King Airway Insertion 6 of 7 Attach a BVM to the KING Airway and while bagging the patient, gently withdraw the tube until ventilation becomes easy and free flowing Confirm chest rise and lung sounds Capnography may be used to confirm placement Revised 11/2013 13 CONFIRMATION

14. King Airway Insertion 7 of 7 Securing the Device After placement has been verified (to include breath sounds) Insert an oral airway to prevent the patient from biting the tube. Secure the tube using tape and C-collar. Revised 11/2013 14

15. When to remove the King Airway The King Airway should only be removed if patient regains a gag reflex and begins to “fight” (reject) the tube Revised 11/2013 15

16. How to remove the King Airway Make sure suction is available and ready Remove tape and airway Lay patient on their side Deflate cuff Slowly remove tube Suction patient as needed Revised 11/2013 16

17. REVIEW QUESTIONS Revised 11/2013 17

18. In Loudoun County, you have standing orders to use the King Airway on patients that are ________. Revised 11/2013 18 Pulseless and Apneic

19. When using the King Airway, inflate Size 4 (Red) with __ to __ cc of air and the Size 5 (Purple) with __ to __ cc of air. Red 60-80 cc Purple 70-90 cc Revised 11/2013 19

20. When using the King Airway, inflate Size 3 (Yellow) with __ to __ cc of air and the Size 2.5 (Orange) with __ to __ cc of air. Yellow 45-60 cc Orange 30-40 cc Revised 11/2013 20

21. When using the King Airway, inflate Size 2 (Green) with __ to __ cc of air. Green 25-35 cc Revised 11/2013 21

22. The Cuff (Balloon) should be inflated after assuring chest rise? TRUE or FALSE Revised 11/2013 22 False

23. If you do not get chest rise when first ventilating the King Airway, you should _______. Slightly pull it back and attempt to ventilate Revised 11/2013 23

24. You should secure the King Airway in place using __________. Collar Tape Bite Block Revised 11/2013 24

25. The King Airway should only be used on patients that are ____ inches or taller. 35 Revised 11/2013 25

26. The King Airway should be inserted until __________. The teeth or gums are at the base of the connector Revised 11/2013 26

27. The EDD (Esophageal Detector Device) should be used to check King Airway placement. TRUE / FALSE Revised 11/2013 27 False

28. Which medications can be administered through the King Airway? None Revised 11/2013 28

29. When used in conjunction with an AED, the King Airway should be inserted after the 3 rd shock or 3 rd No Shock during a cardiac arrest. TRUE / FALSE Revised 11/2013 29 True