Equipment 8-486 - King Airway

CMH EMS & MIH Protocols

Scope of Practice:

Emergency Medical Technician
Advanced Emergency Medical Technician
Registered Nurse
Paramedic

Indications:

Contraindications:

Airway burns.
Responsive patient with intact gag reflex.
Known esophageal disease.
Caustic substance ingestion.

Precautions:

None.

Procedure:

Choose size (see table below).
Test cuff inflation by injecting maximum recommended volume of air into cuffs. Remove all air from cuffs.
Apply lubricant to beveled distal tip and posterior aspect of tube.
Pre-Oxygenate.
Position Head in "sniffing position" or neutral position.
Hold King in dominant hand. Hold open mouth and lift chin with non-dominant hand.
Rotate King 45-90 degrees to touch the corner of the mouth with the blue orientation line.
Advance King behind base of tongue. Never force into position.
As tip passes under tongue, rotate back to midline (blue orientation line faces chin).
Advance King until base of connector aligns with teeth or gums.
Inflate cuffs with minimum volume necessary to seal the Airway at peak ventilatory pressure.
Attach resuscitation bag. While bagging, withdraw King until ventilation is easy and free flowing.
Confirm proper position by auscultation, Chest movement, and ETCO2.
Secure King with tape or other device.
Advanced Life Support:

Continued sedation: Consider Versed 2.5-5 mg every 5 min and/or Fentanyl 50-100 mcg (max 300 mcg).
MANDATORY AFTER INSERTION TO CONFIRM PLACEMENT:

Place up to 18 fr Gastric Tube into the drain tube of the King and advance into the stomach. The gastric tube should be well lubricated and passed slowly and carefully. Suction should not be performed until the gastric tube has reached the stomach.

Sizing Table:

Size	Connector color	Patient criteria	Cuff volume
2	Green	35-45 inches, 2.9-3.8 feet, 12-25 kg	25-35 ml
2.5	Orange	41-51 inches, 3.8-4.3 feet, 25-35 kg	30-40 ml
3	Yellow	4-5 feet	40-60 ml
4	Red	5-6 feet	50-80 ml
5	Purple	Greater than 6 feet	60-90 ml

Citations:

Protocol 9-010 - References

Change Log:

Date	Link to previous version	Description of change
12/15/13	pdf	Added EMT scope of practice statement.
12/15/13	pdf	Added EMT scope of practice statement.
05/05/15	pdf	Added mandatory statement for inserting gastric tube for confirmation.
08/24/17	pdf	Added contraindication for airway burns.
07/04/20		Renumbered the section to allow for future additions.
08/07/20	pdf	Added content (without substantive modification) from old Section 8-160 - King LTSD Airway.
06/15/21	pdf	Moved to emsprotocols.online
12/01/21		Updated link to Versed.
03/20/23		Changed link for Fent.

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