Objectives/Hypothesis To discuss an algorithm for managing the airway in patients presenting with a King LT in place. Study Design Case series at a single institution with planned chart review. Methods This study reviewed the management of three patients who presented to a tertiary academic medical facility emergency department following placement of a King LT at an outside hospital or in the field. Clinical history at admission as well as each patient's hospital course was evaluated. We discuss the management of the airway in each of these cases and use these to help design an algorithm for improving outcomes in patients with a King LT in place. Results In each of the three cases presented, the Otolaryngology Department was consulted for definitive airway management. In two of these patients, the airway was successfully secured using endotracheal intubation. Only one patient required tracheostomy. We discuss an algorithm for managing these patients to obtain a safe airway, which includes assessing the airway with flexible endoscopy and then proceeding with intubation by the Seldinger technique or intubation using a video laryngoscope. In some cases, tracheostomy will be required to definitively secure the airway. Conclusions The King LT is a valuable tool available in the field to help to temporarily secure the airway. Otolaryngologists should have an appropriate airway algorithm for managing patients with a King LT in place to minimize the need for a tracheostomy.