Trauma surgeon Kenji Inaba reviews his approach for a cricothyrotomy at EMRAP Live. When the patient cannot be intubated or ventilated, you need to perform a surgical airway.
As a pre-hospital provider, I once had a trauma patient who required an urgent cric due to severe airway trauma. Upon arriving at the hospital, they quickly performed retrograde intubation through the cric, assisted with a bougie. What benefits are there to taking the time to do this?
We have found at reinserting the laryngoscope blade and having an assistant lift up on it as if we are trying to intubate the patient while performing the cric procedure does 2 wonderful things for us. 1) it brings all of the anterior neck anatomy up into stark relief and it is much easier to no anatomically where you are even on difficult necks; and 2) it stabilizes all of the airway structures is if you had them in a vice on your workbench so that when you are cutting, inserting your finger, inserting stylet, ET tube, or other devices, everything is well stabilized and not moving. The only places we've seen this not work is when the face is so destroyed you can't get a laryngoscope blade in what was the oropharynx, or when the patient has trismus and you are unable to insert the blade. Both of these have occurred in our system but have been quite rare.
Art P. - October 13, 2018 8:01 AM
A simpler technique is the 3 step bougie crich.
arteddoc@msn.com
David S. - December 7, 2019 10:59 PM
How about a single lumen CVC line inserted for a pericardialcentesis if you have nothing else?
Wesley M. - November 8, 2018 9:51 AM
This is the best video on Cricothyrotomy! Thank you!!
Jess Mason - November 8, 2018 1:08 PM
👍
Peter C. - November 13, 2018 12:55 PM
As a pre-hospital provider, I once had a trauma patient who required an urgent cric due to severe airway trauma. Upon arriving at the hospital, they quickly performed retrograde intubation through the cric, assisted with a bougie. What benefits are there to taking the time to do this?
Bobby D. - February 11, 2019 6:29 AM
We have found at reinserting the laryngoscope blade and having an assistant lift up on it as if we are trying to intubate the patient while performing the cric procedure does 2 wonderful things for us. 1) it brings all of the anterior neck anatomy up into stark relief and it is much easier to no anatomically where you are even on difficult necks; and 2) it stabilizes all of the airway structures is if you had them in a vice on your workbench so that when you are cutting, inserting your finger, inserting stylet, ET tube, or other devices, everything is well stabilized and not moving. The only places we've seen this not work is when the face is so destroyed you can't get a laryngoscope blade in what was the oropharynx, or when the patient has trismus and you are unable to insert the blade. Both of these have occurred in our system but have been quite rare.
tom f. - June 9, 2021 8:01 PM
excellent
thank you