This patient suffered a cardiac arrest and was intubated in the field. He arrived in our stabilization room with on going BVM ventilation and LUCAS CPR. He was noted to have massive gastric distension.
Lateral cervical spine x-ray showing King LT-D Airway not placed correctly with tip folded up against the larynx. (click to enlarge)
As you can from the cross table radiograph, the distal tip of the King Airway has wedged itself in the pharynx and folded against itself. It is not seated properly against the hypopharynx. While this was providing ventilation, it also stented open the esophagus leading to a large amount of gastric insufflation.
I’ve seen this before and it has a pretty simple fix in the field. When you place a KingLT, you need to retract it slightly while delivering the initial ventilations. This will help ensure the tip has not curled, and will help “seat” the device to deliver more of the ventilations towards the trachea rather than the esophagus.
In some cases when the tip curls they are unable to appreciate lung sounds and assume the device has failed and pull it out entirely. Again, with a simple easy retraction during the initial ventilations the provider can ensure proper placement of the distal tip.
Great radiographs!
Simple solution to infield intubation is to use a Bougie. Transfer the ETT along the bougie once in place. It is unfortunate that these things happen not only in the field but also in Hospital Resus. Ensuring the tube is tied in place after intubating can also decrease any chance the tube may move. Even the simplest of movements can displace the tube if not firstly inflated and secondly secured. Thanks for sharing