Medical Myths - Cricoid Pressure

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Nurses Edition Commentary

Mizuho Spangler, DO, Lisa Chavez, RN, and Kathy Garvin, RN
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Nicholas N. -

Hi,

Excellent Review. Great to see this topic to resurface. Just wanna give my opinion regarding Minh's points pro Cricoid Pressure. It is true that a lot of medical procedures we are doing are not entirely evidence supported, but in some way these procedures are based on basic sciences and theorectical pathophysiology. Eg given in-line stabilisation for intubation in trauma. But in the case of cricoid pressure, the fundamental of cricoid pressure to occlude the oesophagus has been radiologically proven not effective. I think compressing the esophagus to a point it impairs swallowing does not prove anything about preventing regurgitation which involves separate mechanism.

Being the supporter of non believer of cricoid pressure, i think the fundamental of medicine is still do no harm. The procedure itself is not without risk as mentioned in the podcast, and benefit is based on a debunked idea.

Paul D. -

The fact that we don't have good evidence for inline stabilization as a reason for doing cricoid pressure is fallacious.

Patrick T., M.D. -

i have always thought of cricoid pressure as being used to get a better view in someone with anterior anatomy. i learned it 25 years ago as a medic and still occasionally have a nurse or medic apply it in the ed and multiple times it has helped with visualization of the cords. just my experience.

Anand S., M.D. -

Patrick - thanks for the comment. It sounds like you're talking about bimanual manipulation of the airway. I think most airway people are in favor of bimanual manipulation. This allows us to move the airway (especially an anterior one) into view. Cricoid is a specific, blind maneuver simply aimed at occluding the esophagus. I hope this clarifies. Keep the comments coming!

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