Category Archives: Supraglottic Airway

Question: Can a PCP insert a King LT in a non-VSA patient with a GCS of 3 under the direction of an ACP?

Question: I have a quick question on the PCP supraglottic airway medical directive. What is the rationale for the "must be VSA" condition on the directive for PCP, yet ACP's can use it as a back-up device for failed airway management. Would it not make more sense to make the conditions for PCP something like "Patient must have a GCS=3 and other airway management is inadequate or ineffective"?

The issue here could be two-fold. First, if BVM ventilation is ineffective as a PCP, there is nothing you can fall back on, whereas the ACP can use either ETI or a SGA as indicated. If this ineffective BVM situation occurs as a PCP and the patient is GCS=3, why can't we insert a SGA as a rescue device for ineffective BVM ventilation?

Secondly, with some new evidence beginning to show that SGA's may actually not be as great as we thought in VSA patients, is there a risk we could abandon them entirely from the PCP level, in essence "throwing the baby out with the bathwater" and abandoning a valuable device simply because the conditions for its use were restrictive.

Also, do you have any idea when the new revised BLS standards may be coming out from the MOHLTC? I'm hoping there are new evidence based oxygen therapy guidelines. Any thoughts? Thanks.

Question: In the ALS patient care standards it states that a Supraglottic Airway (King) is indicated when "Need for ventilatory assistance OR airway control AND Other airway management is inadequate or ineffective"

In the "un-controlled" world of EMS would it not be more effective to use a King over an oral airway after the first round of CPR is complete? The King allows for movement from the floor to stretcher with no worry about "losing" your airway. It also doesn't fall out as an oral airway will in the difficult situations/extrications we face in the field. The fear of gastric distention is also completely alleviated, making the King more effective. It would also allow for constant compressions, which is the best treatment for cardiac arrest patients in pre-hospital settings according to the Heart & Stroke. I have had many discussions with other paramedics and they seem to think that you can't use the King at all if you have an oral airway that is giving adequate control. So my question is, if you use the King on VSA patients, is it acceptable even if the oral airway will work (just not as adequately or effectively in my opinion)?