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King Airway

Clinical Indications for Blind Insertion Airway Device (BIAD) Use: Last Update 02/2013

    -Inability to adequately ventilate a patient with a Bag Valve Mask or longer EMS transport distances require a more advanced airway.
    -Appropriate intubation is difficult or impossible due to patient access or difficult airway anatomy.
    -Inability to secure an endotracheal tube in a patient who does not have a gag reflex where at least one failed intubation attempt has occurred.
    -Patient must be unconscious.

Size: King LTSD
Green (size 2): 12-25kg - 25-35ml inflation volume
Orange (size 2.5): 25-35kg - 30-40ml inflation volume
Yellow (size 3): 4-5 feet tall - 40-55ml inflation volume
Red (size 4): 5-6 feet tall - 40-55ml inflation volume
Purple (size 5) >6 feet tall - 60-80ml inflation volume


    1. Preoxygenate the patient.

    2. Select the appropriate tube size for the patient.

    3. Lubricate the tube.

    4. Grasp the patient's tongue and jaw with your gloved hand and pull forward.

    5. Gently insert the tube rotated laterally 45 degrees so that the blue orientation line is touching the corner of the mouth. Once the tip is at the base of the tongue, rotate the tube back to midline. Insert the airway until the base of the connector is in line with the teeth and gums.

    6. Inflate the pilot balloon with 25-80 ml of air depending on the size of the device used.

    7. Ventilate the patient while gently withdrawing the airway until the patient is easily ventilated.

    8. Auscultate for breath sounds and sounds over the epigastrium and look for the chest to rise and fall.

    9. The large pharyngeal balloon secures the device.

    10. Confirm tube placement using end-tidal CO2 detector.

    11. It is required that the airway (if equipment is available) be monitored continuously through Capnography and Pulse Oximetry.

    12. It is strongly recommended that an Airway Evaluation Form be completed with any BIAD use.

Competency Based Skill Requirements:

    Maintain knowledge of the indications, contraindications, technique, and possible complications of the procedure. Assessment of this knowledge may be accomplished via quality assurance mechanisms, classroom demonstrations, skills stations, or other mechanisms as deemed appropriate by the local EMS System. Assessment should include direct observation at least once per certification cycle.

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