WWYD: Butane inhalation & ignition

DesertMedic66 said:
You don’t have to preload the king with a gastric tube. You can place the OG after the King is inserted.

The King also advertises that you can place a bougie down the main BVM port and it should be directed towards the glottic opening at which time you could essentially do a tube exchange via bougie.

The Kings have fallen out of favor in the past couple of years due to overpressure in the balloon causing restricted carotid arteries and jugular vein drainage. There are several other popular options out now with the iGel being one of the main ones, that also has its own issues.
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What issues does the igel have?

The only problem that I was aware of was that of an iGel getting displaced because it was held incorrectly with a Thomas tube holder. You absolutely have to use the elastic band that comes with the iGel to secure it. It needs some downward pressure to ensure it stays seated against the glottis.
 
NomadicMedic said:
What issues does the igel have?

The only problem that I was aware of was that of an iGel getting displaced because it was held incorrectly with a Thomas tube holder. You absolutely have to use the elastic band that comes with the iGel to secure it. It needs some downward pressure to ensure it stays seated against the glottis.
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We have had some issues with the gel in the desert heat and also in some super hyperthermic patients. The downward pressure that you identified is also an issue. If you use the elastic band you may have to readjust it during use as the band gets easily stretched. We stopped using the bands and switched to the Thomas Select tube holder.

The other issue is that the packaging is ridiculously bulky. So we have to store all the iGels in their own separate bag because they won’t fit in our backup airway kit.
 
DesertMedic66 said:
We have had some issues with the gel in the desert heat and also in some super hyperthermic patients. The downward pressure that you identified is also an issue. If you use the elastic band you may have to readjust it during use as the band gets easily stretched. We stopped using the bands and switched to the Thomas Select tube holder.

The other issue is that the packaging is ridiculously bulky. So we have to store all the iGels in their own separate bag because they won’t fit in our backup airway kit.
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Good point about the packaging taking up far too much space, but if I recall correctly - the king packaging wasn't much better.

Just get a McGrath and get better at intubating... (I kid)
 
FiremanMike said:
Good point about the packaging taking up far too much space, but if I recall correctly - the king packaging wasn't much better.

Just get a McGrath and get better at intubating... (I kid)
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The king packaging was much better than the iGel. The king was just simply the airway inside the paper/plastic package so it was much more comparable to a normal ETT.

We carry the CMACs and have over a 94% first pass success rate
 
We looked at iGels a few years ago and found that most of the literature supported a traditional LMA to an iGel, so we stuck with those. I have his ppt somewhere.
 
NomadicMedic said:
The only problem that I was aware of was that of an iGel getting displaced because it was held incorrectly with a Thomas tube holder. You absolutely have to use the elastic band that comes with the iGel to secure it. It needs some downward pressure to ensure it stays seated against the glottis.
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This really should not be the case at all. If the igel is properly sized and seated, no sort of pressure should be required to keep it in place. Some tape is probably a good idea to minimize the chance of dislodging (just like an ETT), but that's about it.
 
FiremanMike said:
Data showed frequent over inflation of the large balloon which was causing airway damage and carotid circulation issues. i-gel was coming out at the same time which didn't have those issues.

King airway faded away
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Thanks, I didn't know that. My former system used kings, and the neighbors used igels; looks like both are available in the protocols. Can you share the studies? I hadn't heard about them.

DesertMedic66 said:
You don’t have to preload the king with a gastric tube. You can place the OG after the King is inserted.
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I've never had any luck putting in the gastric tube after the king was inserted... in fact, I don't know anyone who has. in theory, you don't have to preload, but in practice, you're saving yourself a lot of headaches by preloading it. Kind if like how it's a theoretical function, but in practice, not so much.
 
DrParasite said:
Thanks, I didn't know that. My former system used kings, and the neighbors used igels; looks like both are available in the protocols. Can you share the studies? I hadn't heard about them.


I've never had any luck putting in the gastric tube after the king was inserted... in fact, I don't know anyone who has. in theory, you don't have to preload, but in practice, you're saving yourself a lot of headaches by preloading it. Kind if like how it's a theoretical function, but in practice, not so much.
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I never had an issue with using it when we still had the kings. Use the right size and place a little bit of lube over the opening and it would glide straight down.
 
gastric
DesertMedic66 said:
I never had an issue with using it when we still had the kings. Use the right size and place a little bit of lube over the opening and it would glide straight down.
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IME, gastric tube ports, while in theory are a rational idea, in real world practice don't deliver. Decompressing a distended stomach to increase lung capacity and maybe improve venous return is a good idea, but people that arrest very often have partially digested food in their stomachs which very quickly occlude the fenestrations in the tube and make it useless, especially because of the size that will fit down these channels (16 fr mostly?) Just secure the airway and ensure effective chest compressions and leave the style points for later if the guy survives.
 
DrParasite said:
Thanks, I didn't know that. My former system used kings, and the neighbors used igels; looks like both are available in the protocols. Can you share the studies? I hadn't heard about them.


I've never had any luck putting in the gastric tube after the king was inserted... in fact, I don't know anyone who has. in theory, you don't have to preload, but in practice, you're saving yourself a lot of headaches by preloading it. Kind if like how it's a theoretical function, but in practice, not so much.
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Honestly it was a long time ago and I don’t have the energy to look it up..
 
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