Ditch the Needle, Teach the Knife Part II

Dr. Larson, a well-known anesthesiologist at Stanford once stated that an emergency cricothyrotomy is much quicker, easier, safer and more effective than any needle-based technique. I can state with confidence that there is no place in emergency airway management for needle-based attempts to establish ventilation.

As you all can tell, I love airway topics as it is our forte and it is what we do on a daily basis. I have published one post Ditch the Needle – Teach the Knife! I feel that maybe more emphasis should be placed on this topic even though we rarely run into this situation during our career. Because of its rare occurrence, most anesthesia personal have no real-life experience with this technique. Hence we should better prepare ourselves in case when we need it. We have talked about the bougie-assisted surgical cricothyroidomty that is the recommended technique in can’t intubate, can’t ventilate situation in our last post. If you watch this video below, you can perform the cricothyroidotomy by yourself as well. Technicality-wise, it is not difficult — you can do it without any formal training, maybe youtube training to accomplish the procedure.We just need to know the steps how to perform this procedure to save lives.

What you need:

(1) a bougie

(2) a scalpel

(3) ET tube 6.0.

(4) Watch the video and you will see yourself why it is the go-to-method to bail you out in airway crisis situation.

erprocedurecricothyrotomylandmarkskin

6 Comments Add yours

  1. Jim says:

    Apologies for not replying to you earlier: I was trying to find this article: http://onlinelibrary.wiley.com/doi/10.1111/j.1460-9592.2009.02996.x/full

    It describes a range of different cric systems and it’s suitablilty for pediatrics. Also it points out the technical difficulties for surgical approach such as the small dimension of the pediatric cricothyroid membrane.

    In our institution we have a standardized cicv-pack consisting of 2 sides: Adult/surgical (scalpel-bougie-tube) and Pediatric/needle (angiocath-syringe-saline-jet oxygenation tubing)

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  2. Jim says:

    Also this: http://pedemmorsels.com/cant-intubate-cant-ventilate/

    If you cam’t locate the ctm, go tracheal

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    1. Behind The Drape says:

      Thank you Jim for the info. I may write a post on the pedi difficult airway management in the near future. It would be good for the learning since I do mostly adult cases. It would be a good learning material for the readers as well.

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  3. Gertrude says:

    Tiens, je me demandais comment vous alliez faire avec vos mains pour écrire 20k03m ! Je vous suis avec attention et bcp de plaisir. Bonne route.Bien amicalement!

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