4. Continue to ventilate with 100% Oxygen5. Position head in the sniffing position. If trauma is present, in-line neutral position is appropriate.6. Without using excessive force, advance the tube until the base of the connector is aligned with theteeth or gums7. Inflate cuff based on size of tube (shown above)8. Attach BVM and gently ventilate while withdrawing tube slowly until ventilation is easy and free flowing9. Attach bag valve device and verify placement by
of the following:Rise and fall of the chestBilateral breath soundsAbsent epigastric soundsETCO2 capnography / capnometry If there is any question about the proper placement of the King Airway, deflate the cuffs and removedevice, ventilate the patient with BVM for 30 seconds and repeat steps 2-8 aboveSecure the tube with a commercial tube holder. Note depth marking on tubePlace C-collar to help prevent accidental dislodgement
Continue to monitor the patient for proper tube placement throughout prehospitaltreatment and transport. This includes using ETCO2 and documenting it on alltubed patients.
The anatomical position of the King Airway can make it prone to dislodgement. If you are not able toventilate, it is important to remember the following trouble shooting tips Pass the tube from the corner of the mouth
If no trauma is noted, place the patients head in the sniffing position
Use a curved blade to assist the insertion of the king(Like a tongue depressor)
use the most correct size from the start and go to a bigger size tube if needed
monitor SaO2 and CO2 metrics constantly
If visual, ETCO2 or other factors that lead you to believe the tube is clogged,begin suctioning, re confirm proper placement
Patient becomes conscious.
Removal of the King airway, while may be necessary, is a dangerous proposition due to the high risk of aspiration. If you need to remove it, vs. sedating the patient, follow the steps below
Remove the tube holder
Completely deflate the balloons
Gently remove the airway
Have suction ready
Assure patient airway once it is removed. Always be ready to control the airwayagain if needed. If patient is awake, but cannot control their own airway, consider administering sedation or paralytics per protocol.
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