DATE: TO: FROM: RE: January 31st, 2012 All Clackamas ALS Employees Tina Beeler - CES Pediatric King Airways

We now have pediatric King Airways in stock. Please see your supervisor for distribution. Directions for use are the same as the adult. Adult and Pediatric King Airway

1. Select appropriately sized King Airway: a. Size 2 – Pediatric patient 3 – 3.5 feet tall (25-35 ml air) b Size 2.5 – Pediatric patient between 3.5 – 4 feet tall (30-40 ml air) c. Size 3 – Patient between 4 and 5 feet tall (55 ml air) d. Size 4 – Patient between 5 and 6 feet tall (70 ml air) e. Size 5 – Patient over 6 feet tall (80 ml air) 2. Assure patient is being ventilated with 100%O2. 3. Check King Airway cuffs to ensure patency. Deflate tube cuffs. Leave syringe attached then lubricate the tip of the tube.

9800 SE McBrod Milwaukie, Oregon 97222

4. Continue to ventilate with 100% Oxygen 5. 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 the teeth or gums 7. 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 flowing 9. Attach bag valve device and verify placement by ALL of the following: Rise and fall of the chest Bilateral breath sounds Absent epigastric sounds ETCO2 capnography / capnometry If there is any question about the proper placement of the King Airway, deflate the cuffs and remove device, ventilate the patient with BVM for 30 seconds and repeat steps 2-8 above Secure the tube with a commercial tube holder. Note depth marking on tube Place C-collar to help prevent accidental dislodgement Continue to monitor the patient for proper tube placement throughout prehospital treatment and transport. This includes using ETCO2 and documenting it on all tubed patients. Troubleshooting: The anatomical position of the King Airway can make it prone to dislodgement. If you are not able to ventilate, 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 airway again if needed. If patient is awake, but cannot control their own airway, consider administering sedation or paralytics per protocol.

9800 SE McBrod Milwaukie, Oregon 97222

9800 SE McBrod Milwaukie, Oregon 97222

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