Toys

[RichmondMedik]

So does anybody have any new items they use in their service

as stated we have the autopulse - Sternal I/O for now( changing to the easy I/O) fiber optic intubation kit -- these are the ones I can think of for now

Paul

[BringItOn]

We have EZ I/O, CPAP, vents, toughbooks - that's all I can think of for now too.

Has anyone used the new King tubes? They are poised to replace the Combitube. I trialed them at the conference I went to this weekend - very cool for a rescue device AND you can pass a bougie thru them. I planted myself firmly in my MSO's office Monday morning and showed him all the paperwork on them. They run only $22 apiece. Cool stuff!

[jdemaio]

We're getting our toughbooks soon, that's about it. We were told that we aren't getting the Easy IO due to the cost, oh well.

[kjrff23]

Has anyone used the new King tubes? They are poised to replace the Combitube.
Great....just great......we haven't even got the Combitubes yet and they are already being replaced. Then again we haven't gotten printed EMT licenses since 1999....................

[safdrookie]

We have EZ I/O, CPAP, vents, toughbooks - that's all I can think of for now too.

Has anyone used the new King tubes? They are poised to replace the Combitube. I trialed them at the conference I went to this weekend - very cool for a rescue device AND you can pass a bougie thru them. I planted myself firmly in my MSO's office Monday morning and showed him all the paperwork on them. They run only $22 apiece. Cool stuff!

We got to play with the King tubes in BTLS class on tuesday. they seem pretty cool. but then again i'm still very fresh and haven't tubed anyone yet but they are cool on the maniquin. just my 2 cents.

[jdemaio]

We don't even carry combitubes or anything like them, we use LMAs as an ET backup.

[kjrff23]

Our back-up used to be EOA's, but I think they are gone now.

[jdemaio]

Our back-up used to be EOA's, but I think they are gone now.
I should hope so, that's friggin dinosaur medicine.

[musicemt]

JD, how do those LMAs do in the back of a moving truck? I'm trying to get some rescue airways in the protocols where I work for the BLS trucks, and the argument was raised that LMAs would probably dislodge in a moving truck more easily, based on how they're designed.

[kjrff23]

I should hope so, that's friggin dinosaur medicine.
Our State EMS office address is 3 Jurassic Park, Providence...................

Actually there are now only 2 people working in the EMS office now and what we've been told is that if we get the entire department current with the latest ACLS standards we can have the Chief send a letter stating we are going to follow the current ACLS guidelines and we will get anything in there as long as our medical director signs off on it.

[jdemaio]

JD, how do those LMAs do in the back of a moving truck? I'm trying to get some rescue airways in the protocols where I work for the BLS trucks, and the argument was raised that LMAs would probably dislodge in a moving truck more easily, based on how they're designed.
They work very well. I have never had a problem with them migrating. They need to be secured kind of like an ETT, you can't just put it in and leave it without securing it. I'm sure that if it was improperly secured or not secured at all, that it would shift or come out. Do your state laws allow EMTs to use rescue airways? I know that in CT, EMT-Bs can't use them, but EMT-Is can use combitubes only, it's kinda messed up.

[jdemaio]

Our State EMS office address is 3 Jurassic Park, Providence...................

Actually there are now only 2 people working in the EMS office now and what we've been told is that if we get the entire department current with the latest ACLS standards we can have the Chief send a letter stating we are going to follow the current ACLS guidelines and we will get anything in there as long as our medical director signs off on it.
That's not bad, is your MD cool, does he trust you guys? Is your FD an ALS 1st responder or the transporting unit? If you can get anything you want...CPAP and RSI is the way to go.

[1medicprincess]

Gee wish we had some new toys comming our way. We have had the combi-tubes for about 18 months and the last big thing we got was morephine 2 years ago along with our needle decompression kits......

[medicmade]

we are getting a new vent that can do peep and all that fancy stuff, and i think The new easy IO.

[RichmondMedik]

We are getting the King tubes by the end of the year - we have the toughbooks -- we also have a seperate department called make ready -- they wash and restock the units at the end of our shifts.

Paul

[jdemaio]

What are King Tubes?

[RichmondMedik]

What are King Tubes?


Here is the website for them

http://www.kingsystems.com/PRODUCTS/AirwayDevices/EMS/tabid/88/Default.aspx

suppose to be easier than a combi tube

Paul

[medicgoddess]

we also have a seperate department called make ready -- they wash and restock the units at the end of our shifts.

Paul

I WANT ONE OF THOSE!!!!! And the maintenance dept back in Shelby county so that our trucks will run.

[kjrff23]

Here is the website for them

http://www.kingsystems.com/PRODUCTS/AirwayDevices/EMS/tabid/88/Default.aspx

suppose to be easier than a combi tube

Paul
OK, so I checked out the site but still don't know how we are inserting this. Are there 2 airway routes on top like a combi-tube or is this stopping short of the trachea?

[Dorkfish]

From the picture it looks like one tube . If it stops short , wouldn't that let air go to the stomach ? I thought air + stomach = puke in my ambulance . Not a big fan of that . Need more info than the picture .

[kjrff23]

Yeah, I'm thinking we need more info here. My best guess is that it has something to do with the balloons.

[Turk II]

Here is the website for them

http://www.kingsystems.com/PRODUCTS/AirwayDevices/EMS/tabid/88/Default.aspx

suppose to be easier than a combi tube

Paul

I played with the King LTD at a Difficult Airway Management Class... loved it. It was simple to insert, there was no guess work, and once it was in it was in until the cuffs were deflated. From what I've heard they also do a good job of protecting the patient from aspirating and you can pass an ET tube through the King LTD once it is in place also.

Unfortunately I don't have any real life experience... my service uses LMA's for a rescue airway. I don't have any complaints of the LMA either... it saved my ass a few months ago when I couldn't get a tube on a comically large individual.

[BringItOn]

They are shaped differently than Combitubes. They are alot less bulky to insert. When you hit the back of the throat, you stop and the tube is seated by the two balloons in the esophagus. The top part of the tube allows air into the trachea, you can also pass a bougie thru it. The back part of the tube has a port to pass a gastric tube thru if you need to. This is seen as a rescue device, you would still need to ET the person to fully protect their airway, but you could do that with the bougie after you oxygenated them thru the King. Does that help at all? I'm talking with my hands as I type this......

[Dorkfish]

They are shaped differently than Combitubes. They are alot less bulky to insert. When you hit the back of the throat, you stop and the tube is seated by the two balloons in the esophagus. The top part of the tube allows air into the trachea, you can also pass a bougie thru it. The back part of the tube has a port to pass a gastric tube thru if you need to. This is seen as a rescue device, you would still need to ET the person to fully protect their airway, but you could do that with the bougie after you oxygenated them thru the King. Does that help at all? I'm talking with my hands as I type this......

That's OK , I'm listening with my eyes . Sounds very simular to a combi tube . In Bama , EMT Basic are supposed to be able to use combi tubes but I don't think it is clear when and where we can . Guess the King tube is another neat thing we will not be able to use . Thanks for the description , makes things a little more clear .

[jdemaio]

In Bama , EMT Basic are supposed to be able to use combi tubes but I don't think it is clear when and where we can .
Whew, good thing that you're a SuperBasic.

[medic pathetic]

You know, the website says that it can potentially be used by first responders when in critical situations. In my area all first responders are at least EMTs. Among other things you get when you are cleared to be a first responder is an O2 cylinder and a Zoll AED. It makes sense to me that certain first responder EMTs be given one provided they have been adewuately trained in it's usage. Here medics have to call for permission for chemical sedation and RSI if using Succs. I'd like to be able to establish an airway if i'm first responding to a critical pt out in BFE when the the closest truck is still 12 mins away and in rush hour traffic.

In conclusion, I want one.

[kjrff23]

They are shaped differently than Combitubes. They are alot less bulky to insert. When you hit the back of the throat, you stop and the tube is seated by the two balloons in the esophagus. The top part of the tube allows air into the trachea, you can also pass a bougie thru it. The back part of the tube has a port to pass a gastric tube thru if you need to. This is seen as a rescue device, you would still need to ET the person to fully protect their airway, but you could do that with the bougie after you oxygenated them thru the King. Does that help at all? I'm talking with my hands as I type this......
That's the best explanation I've seen so far. So basically it works on the same principle of an EOA/EGTA. You are blocking the esophagus to send the air thru to only other hole. i'm glad you mentioned that you still need to tube someone. I had an instructor in Cardiac school that had a tape of a properly inserted EOA and the Anesteiologist {sp?} MD sunk 4 ET tubes uninflated around the EOA tube at 12,3,6, and 9 O'Clock. That really drove home the fact that the esophagus stretches that much and it's not fool-proof to stop aspiration.

[BringItOn]

That's the best explanation I've seen so far. So basically it works on the same principle of an EOA/EGTA. You are blocking the esophagus to send the air thru to only other hole. i'm glad you mentioned that you still need to tube someone. I had an instructor in Cardiac school that had a tape of a properly inserted EOA and the Anesteiologist {sp?} MD sunk 4 ET tubes uninflated around the EOA tube at 12,3,6, and 9 O'Clock. That really drove home the fact that the esophagus stretches that much and it's not fool-proof to stop aspiration.

Yup - The King's are to be used instead of Combitubes, the cool thing about them is there is only one syringe that inflates both cuffs so you don't have to guess where your tube is and make sure both syringes aren't flopping all over the place....it's much more compact.

I hear that some agencies are carrying LMA's now as a rescue device. Those are billed as only able to occlude 90% of the esophagus. From what I've studied, the only definitive way to protect the airway from aspiration is still the ETT. There are lots of nifty rescue devices for difficult airways though. And easy ways of predicting a difficult airway. The course I went to a couple of weeks ago was excellent. You can read about it on www.theairwaysite.com. Look up the one for EMS. If there is ever one offered in your area, it is well worth the effort to go.

[kjrff23]

That's not bad, is your MD cool, does he trust you guys? Is your FD an ALS 1st responder or the transporting unit? If you can get anything you want...CPAP and RSI is the way to go.
Sorry this took so long, I didn't see this post right away. To answer you questions, the pathetic RI politics and red tape prevail here. We currently have no medical director since we actually transport to Mass hospitals and no one knows our protocols and what to do with us. We have problems buying and exchanging outdated meds with the pharmacies. Neither of the two primary hospitals we use have a 24 hour pharmacy so we have to go back the next day a replace meds sometimes. We are the primary ALS provider in town and my engine is a non-transporting ALS unit, paramedic level. We can get some things we want, like we did a few pilot programs in RI and all our Basics can orally intubate and all of us cardiacs can pace. Mass doesn't give us a hard time about that stuff but we have different meds than the region we transport into. Our medics have a med or two that Mass uses, like Cardizem, that RI doesn't have but they let us exceed the protocol as long as all the RI stuff is there. As far as CPAP and RSI, not anytime soon. Our licenses expire in March and no one has even got renewal paperwork in the mail yet from RIEMS and we only have 2 refresher classes left to go. Our EMS office pretty much exists on paper right now and they are looking at a 15% budget cut for next year. So then we'll have 1.85 people working up there instead. There used to be 24.

[jdemaio]

Sorry this took so long, I didn't see this post right away. To answer you questions, the pathetic RI politics and red tape prevail here. We currently have no medical director since we actually transport to Mass hospitals and no one knows our protocols and what to do with us. We have problems buying and exchanging outdated meds with the pharmacies. Neither of the two primary hospitals we use have a 24 hour pharmacy so we have to go back the next day a replace meds sometimes. We are the primary ALS provider in town and my engine is a non-transporting ALS unit, paramedic level. We can get some things we want, like we did a few pilot programs in RI and all our Basics can orally intubate and all of us cardiacs can pace. Mass doesn't give us a hard time about that stuff but we have different meds than the region we transport into. Our medics have a med or two that Mass uses, like Cardizem, that RI doesn't have but they let us exceed the protocol as long as all the RI stuff is there. As far as CPAP and RSI, not anytime soon. Our licenses expire in March and no one has even got renewal paperwork in the mail yet from RIEMS and we only have 2 refresher classes left to go. Our EMS office pretty much exists on paper right now and they are looking at a 15% budget cut for next year. So then we'll have 1.85 people working up there instead. There used to be 24.
Sounds like you guys are kinda in limbo right now.