backup ED airway question

[diphenyl]

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I had a backup airway question I hope you gas guys could answer. One of my Pt's the other day came in with a King's airway in. He was a full arrest in the field, evidently a tough tube, so EMS through it in. When he comes to me he has vital signs back and we go through the usual workup. Before I send him upstairs, I want to put in a more definitive airway w/ a ETT. As far as I'm told, the King's doesn't provide as good of aspiration protection vs an ETT. The ICU wants me to change it down in the ED vs having an airway emergency up on the floor. When I compare this tube to the previous combitubes, it's a bot confusing. With the old two channel combitubes, I could tell by which port we were using whether or note the airway was in the trachea. With the king's airway, there is no way to tell where it is as it ventilates through both locations (high and down where the trachea would be) simultaneously. If you don't know where it is, there is no point trying to use a tube exchanger which it is supposed to be able to accommodate.
I eventually just extubated and reintubated w/ a ETT. Was there a better way guys?

 

[Paseo Del Norte]

I had a backup airway question I hope you gas guys could answer. One of my Pt's the other day came in with a King's airway in. He was a full arrest in the field, evidently a tough tube, so EMS through it in. When he comes to me he has vital signs back and we go through the usual workup. Before I send him upstairs, I want to put in a more definitive airway w/ a ETT. As far as I'm told, the King's doesn't provide as good of aspiration protection vs an ETT. The ICU wants me to change it down in the ED vs having an airway emergency up on the floor. When I compare this tube to the previous combitubes, it's a bot confusing. With the old two channel combitubes, I could tell by which port we were using whether or note the airway was in the trachea. With the king's airway, there is no way to tell where it is as it ventilates through both locations (high and down where the trachea would be) simultaneously. If you don't know where it is, there is no point trying to use a tube exchanger which it is supposed to be able to accommodate.
I eventually just extubated and reintubated w/ a ETT. Was there a better way guys?

The King is designed for oesophageal placement only. The newer King LTSD has a second port that will not allow you to attach a bag valve device, and that port is designed for gastric intubation and decompression.

However, the King has a ramped opening that is said to facilitate the placement of a bougie through the glottis and exchange of the King out for an endo-tracheal tube*. I have some literature (how to use it) attached below. King's are used extensively in my area and are part of my back up protocols/failed airway protocols.

http://www.scdhec.gov/health/ems/ResourcesKingLT.pdf

I have open access to all this equipment and could easily shoot some video and perhaps link to this thread; however, I bet there is a fair amount to be found on sites such as You Tube.

Hopefully that helps.

*I've never exchanged it in the field and prefer not to mess with a functioning airway until I can get a patient to a person above my pay grade.

 

[jetproppilot]

I had a backup airway question I hope you gas guys could answer. One of my Pt's the other day came in with a King's airway in. He was a full arrest in the field, evidently a tough tube, so EMS through it in. When he comes to me he has vital signs back and we go through the usual workup. Before I send him upstairs, I want to put in a more definitive airway w/ a ETT. As far as I'm told, the King's doesn't provide as good of aspiration protection vs an ETT. The ICU wants me to change it down in the ED vs having an airway emergency up on the floor. When I compare this tube to the previous combitubes, it's a bot confusing. With the old two channel combitubes, I could tell by which port we were using whether or note the airway was in the trachea. With the king's airway, there is no way to tell where it is as it ventilates through both locations (high and down where the trachea would be) simultaneously. If you don't know where it is, there is no point trying to use a tube exchanger which it is supposed to be able to accommodate.
I eventually just extubated and reintubated w/ a ETT. Was there a better way guys?

I would've done exactly as you did.

 

[diphenyl]

I even tried the back door by using a Chest film to see if I could see if it was in the trachea. The tube is so short, there was no way to tell radiographically. At least it was an easy tube. If he had truly been a difficult tube in the field and then add some edema from the traumatic placement of a king, could have been bad news.