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King LTS-D Airway

King LTS-D Airway. Self-learning Module Practical Review. 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.

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King LTS-D Airway

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  1. King LTS-D Airway Self-learning Module Practical Review Maryland ExpressCare_2009

  2. 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 Objectives Maryland ExpressCare_2009

  3. 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

  4. 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

  5. SECTION 1 Upper Airway Anatomy & Review of Artificial Airway Options Maryland ExpressCare_2009

  6. Upper Airway Anatomy Maryland ExpressCare_2009

  7. Common Non-surgical Artificial Airways Maryland ExpressCare_2009

  8. Oral AirwayNasal Airway • Oral airway placed into the oropharynx • Nasal Airway placed into the nasopharynx Maryland ExpressCare_2009

  9. Combitube Maryland ExpressCare_2009

  10. Endotracheal intubation Maryland ExpressCare_2009

  11. LMA-Laryngeal Mask Airway Maryland ExpressCare_2009

  12. King LTS-D Maryland ExpressCare_2009

  13. Section 2 King LTS-D • Introduction • Placement • Use • Contraindications/Warnings Maryland ExpressCare_2009

  14. King LTS-DDescription • 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

  15. King LTS-DIndications 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

  16. King LTS-DBenefits • 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

  17. King LTS-DWarnings/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

  18. King LTS-DContraindications • 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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  21. King LTS-DResearch • 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

  22. King LTS-DInsertion Maryland ExpressCare_2009

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  28. King LTS-DAdditionally • 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

  29. Section 3 – MIEMSS optional protocol review Maryland ExpressCare_2009

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  33. Post – Test questions • Place the answers to the following questions on the separate Post – Test and Practical Experience Verification form. Maryland ExpressCare_2009

  34. 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 : • a. 3 • b. 4 • c. 5 • d. 6 Maryland ExpressCare_2009

  35. 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. • a. TRUE • b. FALSE • 6.In Maryland, a size 2 or 2.5 LTS-D tube can be used for a pediatric patient according to their height. • a. TRUE • b. FALSE Maryland ExpressCare_2009

  36. 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 : • a. TRUE • b. FALSE Maryland ExpressCare_2009

  37. 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

  38. Conclusion • Please turn in your answers to an approved evaluator and complete the practical experience to finalize this training. Maryland ExpressCare_2009

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