Verde Valley EMS
Educational Outcome
To enable EMS providers to
appropriately, effectively, quickly and
safely utilize the King LT-D® (KLTD)
and King LTS-D® (KLTSD) airway
devices in the prehospital
environment.
Advantages of the KLTD/KLTSD
• Easier to place and use.
 One port to inflate
 One tube to ventilate
 Does not require extensive skill training
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Can be placed quickly.
Provides a means for positive-pressure ventilation.
No interruption of CPR necessary.
Little or no spinal movement necessary.
Lower incidence of sore throat and trauma.
Advantages of the King
continued
• Smaller than other devices (e.g., Combitube).
• More cost-effective than other options.
• Minimizes gastric insufflation.
• LTS-D enables passing of gastric tube into stomach.
• Comes in various sizes.
#3: 4–5 feet
#4: 5–6 feet
#5: Greater than 6 feet
Research & Experience
• Preliminary research.
 Formal studies of the King LT-D/LTS-D are limited, but suggest
positive results.
 Prehospital studies of the King LT-D/LTS-D are currently
ongoing, and others will be published soon.
 Research articles available on the King System’s website
(www.kingsystems.com).
• Other agencies seeing positive results.
 As of February 2007, Clackamas County Fire District #1 had
done 21 insertions with a 90% success rate.
 Anecdotal evidence from Clackamas suggests a higher rate
of ROSC in cardiac arrest patients intubated with the King.
Disadvantages
• Patient must be unresponsive without a gag reflex.
Design of the King LTS-D
Pilot Balloon
Proximal Opening
of Gastric Access
Lumen
Primary Ventilatory
Opening
Proximal Cuff
Stabilizes tube &
seals oropharynx
Multiple Distal
Ventilatory Openings
Bilateral Ventilation
Eyelets
Distal Opening of
Gastric Access
Lumen
Distal Tip & Cuff
Anatomically shaped to assist
in passage behind larynx and
normally collapsed esophagus
King LTS-D Design
Distal tip and
cuff flattened
for more
anatomical fit
behind larynx
Multiple outlets
and bilateral
eyelets, in
order to obtain
best ventilation
continued…
Ramp directs
tube exchange
catheter out
main ventilatory
opening
Comparison of Tube Sizes
Range: 45–60 ml
Range: 60–80 ml
Range: 70–90 ml
Indications
• When tracheal intubation indicated, but unsuccessful
or unavailable.
• Access to the patient is limited (e.g., trauma patients,
entrapment, etc.).
• Difficult or emergent airways, in which other options
may not be feasible.
• Cardiopulmonary arrest (optional).
Contraindications
• Presence of gag reflex.
• Caustic ingestion.
• Obstructed airway.
Same contraindications
as the Combitube
• Esophageal trauma or disease.
Insertion Procedure
• Have all equipment ready prior to attempt.
• Test cuff inflation system for leaks.
• Apply a water-soluble lubricant to the
posterior distal tip of the device.
• Hold KLTD/KLTSD in dominant hand at
proximal connector.
• Use a superior (to patient’s head) approach.
• Perform tongue-jaw lift while keeping head
in a neutral position.
 Head can be slightly extended or placed in the “sniffing”
position if needed to facilitate placement.
Insertion Procedure
• With the King LT (S)-D
rotated laterally 45-90
degrees such that the blue
orientation line is touching
the corner of the mouth,
introduce tip into mouth
and advance behind base
of the tongue.
• As the tube passes under
the tongue, rotate the tube
back to midline (blue
orientation line faces chin).
continued…
Patient Insertion
Insertion Procedure
continued…
• Without excessive force, advance tube until connector is
aligned with teeth and/or gums.
It is important that that the
King is advanced all the way.
Insertion Procedure
• Using a syringe, inflate the cuffs
with the appropriate volume of air.
• Special (reusable) color-coded
syringes can be utilized.
#3: 45–60 ml
#4: 60–80 ml
#5: 70–90 ml
continued…
Insertion Procedure
• Attach BVM to 15 mm connector.
• While ventilating, simultaneously
withdraw until ventilation is easy
and free-flowing.
 There should be good tidal volume
with minimal resistance.
continued…
Insertion Procedure continued…
• Perform standard evaluation of lung sounds while
ventilating through the King LT-D/LTS-D.
• Attach and utilize end-tidal CO2 monitoring while the
King LT-D/LTS-D is in place.
• Readjust cuff inflation as needed.
• Consider securing with tape or ET tube holder.
 Securing with tape or ET tube holder not required, but
recommended.
 With cuffs inflated, King tends to fit snugly and securely.
Proper Position of the KLTD/KLTSD
The KLTSD Gastric Access Lumen
• Lubricate gastric tube prior to
inserting into the gastric access
lumen.
• Up to an 18 Fr catheter may be
utilized.
• Attach suction unit to catheter.
• Once stomach contents are evacuated
and suction no longer necessary,
suction device may be detached.
• Catheter may left in place to “plug”
lumen, and to continue to
decompress the stomach.
Important Points & User Tips
• To avoid tracheal placement maintain head in a neutral
position. Ventilation will not occur if placed in the
trachea.
• If unable to ventilate, remove device and replace.
• If water soluble lubricant used, do not apply near
ventilatory openings.
• Be prepared to re-inflate cuffs with another 10–15 cc in
the event of air leakage (do not over-inflate).
• Insertion depth is critical, as the ventilatory openings
must align with the laryngeal opening.
Important Points
continued…
Be certain to advance the King LT-D/LTS-D
until the base of the connector is aligned with
the teeth and/or gums…
Failure to do so may result in
a failed intubation attempt!
Return of Spontaneous Breathing
• If patient regains consciousness and respiratory
drive, and is not tolerating the King, consider
extubation.
 Place them on their side and fully deflate cuffs.
 Gently withdraw the tube.
 Have suction ready and be prepared for vomiting.
• If patient regains respiratory drive, but remains
unconscious but combative:
 Consider sedation with midazolam and vecuronium.
 Continue providing or assisting ventilations as
necessary.
Spontaneous Breathing
continued…
• During spontaneous breathing, the epiglottis or
other tissue can be drawn into the ventilatory
openings.
 This can result in obstruction.
 Advancing the King 1–2 cm normally eliminates
this obstruction.
King LTD Airway 2.0 & 2.5
Questions?
Questions?
Questions?