Can an emergency Cric patient wake up?

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mos11b1p

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I went to EMT school in 1988. Although I never served formally in the field after that training, I consider it some of the most useful schooling I have ever had because the skills have been applicable throughout my entire life since then. After recently picking up an Emergency First Responder cirtification as part of a PADI Divemaster program, the proceedures for a total airway obstruction got me thinking about emergency cricothyrotomy and some other issues. My first question is: Any suggestions on the best size/shape/style of forcep/hemostat for going in with a disposable laryngoscope and trying to fish out the obstruction? 2nd: If a victim passes out from the obstruction, help is too far away, and a cric is the only option...can a victem actually "wake back up" once the airway is reestablished? (only to find themselves supine with a hole in their neck and a tube sticking out.) ?

Sincerely,

Dave
Loudon, TN
 
mos11b1p said:
My first question is: Any suggestions on the best size/shape/style of forcep/hemostat for going in with a disposable laryngoscope and trying to fish out the obstruction?
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The one that works.

Magills, adult and pedi sizes, are standard, but I don't think anyone will complain about using one that works... Magills are just standard because of the length and shape that facilitates it.


2nd: If a victim passes out from the obstruction, help is too far away, and a cric is the only option...can a victem actually "wake back up" once the airway is reestablished? (only to find themselves supine with a hole in their neck and a tube sticking out.)
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Yes, there's a chance that they can regain consciousness once they have an airways established and are getting ventilations.
 
Yes, there's a chance that reliving hypoxia will cause the patient to regain consciousness.

However, cricothyrotomy isn't something I'd do without a medical director. I SURE wouldn't do it without formal education.
 
I have no intentions of attempting any such procedure! It is simply genuine curiosity. A line in the book read "a total airway obstruction is as serious an emergency medical condition as cardiac arrest" and in layman first responder training, they teach us to treat it is as though it were a cardiac arrest. When the victim drops out after failure to dislodge the object, you go straight to chest compressions. I asked "what about abdominal thrusts, finger sweep, attempt to ventilate, repeat?" They said "nope...chest compressions like heartattack victim." I said but her heart is still beating...she is not dead....she just passed out from hypoxia. breaking all her ribs and disruppting the mechanical operation of her heart doesnt seem the best plan to respond to a total airway obstruction. "nope...straight to chest compressions....that is the standard." Even though I have never seen a choking victem...nor do I even have an immediate family member or friend who knows of one...I decided to add a disposable laryngoscope and pair of forceps to my first responder kit. Am i thinking logically/appropriately?
 
Sound? Sure. Legal? Probably not.

In all the places I've worked, EMTs have been relegated to JUST the AHA guidelines for FBAO. Laryngescopes and Magills have always been reserved for levels that can intubate (Paramedics and sometimes Intermediates), whilst TTO/Crics have been kept for Paramedics only.



If you work for an agency, volunteer or not, I think your med director would be the ones to ask if you can have those items.
 
If you, as a "first responder", stuck a laryngoscope blade in my mouth to "fish out an obstruction"... after I thanked you for doing whatever you did, I'd get a lawyer and sue your ***.
And then I'd own your house. I'd own your car. I'd own every dollar you made.
It's not worth the hassle of a lawsuit and losing everything for the thrill of practicing outside your scope. Get rid of that laryngoscope and McGills and that "first responder kit". If you want to play Ricky Rescue, go back to school, get recertified as an EMT or medic and do the job.
Otherwise, leave it alone.
Sorry to sound harsh, but imagine if some guy came to an online forum and said, "I'm not a doctor, but I was premed in 1988. I'm wondering what sort of scalpel I should use for a Laminectomy. I'm not planning on doing one, of course, but in case someone has back pain, I'd like to be ready with a kit of surgical tools."
 
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n71xi...point made. I am listening. (I make no apologies for being a layperson and coming on this board with honest questions. Ignorance is not a crime. Acting ignorantly most surely can be though. Hey...you dont know if you dont ask and I knew I would get critical feedback and an education if I asked some honest questions here. And despite being lambasted, I would not hesitate to ask OTHER honest questions) Im not interested in being a medical vigilanty. And I certainly did not intend to "minimize" the depth or complexity of the skills of your profession with my word choices, and in so doing, insult.(But your equating proper laryngoscope and forcep use to that of performing back surgery is a stretch...a BIG stretch, even arrogant, no?) I have no interest in playing "Ricky Rescue." Infact, your profession didn't interest me sufficiently to pursue it when i DID complete training. However, life has a way of bringing the situations to you, whether u want them or not. I watched a 19 year-old combat medic do a cric in about 30 seconds under duress...as guess the old latin adage "todo esta facil para el que sabe" applies. ("everything is easy for he who knows.") Fortunately for me, one person actually wrote me a private message and explained WHY it's a bad idea to contemplate the things I've inquired. (For example, who knew you could yank somebody's vocal chords out in an honest effort to dislodge an object? I had no idea.) Perhaps getting formal training and certification for none other than personal knowledge is the right direction after all. Thankyou all for honest and consistant input on my inquirey. Peace.
 
Maybe you need a CPR class?

They are supposed to go into the rationales for why the procedures for airway embarrrassment etc have changed.

FORCEPS: ONLY with visualization and that means either it is hanging out of the mouth, or you are qualified to use a laryngoscope. Otherwise we call that type of forcep the "Ramrod Forcep" because it jams the bolus farther down. (See medical history museum under "Chokesavers").

CRIC: as said above, this is no longer an emergency measure for people not certified directly to do it. Too many people slipped or did it on a conscious heaving pt and either stuck the thyroid, or the other important structures thereabout, or started and quit for one reason or another. (Per my anatomy instructor in college).

Can they wake up? : if it is done right, and it is not too late. The way this anatomy professor put it, you don't do hit until they are "out" so they hold still; if they are out, they probably need to have some ventilatory assistance.

Lots of changes, do not fall back on your experience, use your current training.
 
mos11b1p said:
When the victim drops out after failure to dislodge the object, you go straight to chest compressions. I asked "what about abdominal thrusts, finger sweep, attempt to ventilate, repeat?" They said "nope...chest compressions like heartattack victim." I said but her heart is still beating...she is not dead....she just passed out from hypoxia. breaking all her ribs and disruppting the mechanical operation of her heart doesnt seem the best plan to respond to a total airway obstruction. "nope...straight to chest compressions....that is the standard."
Click to expand...

Just to speak to this quickly --- the dangers of performing CPR on someone with a beating heart used to emphasised in CPR courses a few years ago.

However, a lot of research suggested that the even professional rescuers were quite poor at identifying carotid pulses, and that many lay rescuers were withholding CPR on patients who were pulseless because they beleived (in error) that they could feel a pulse.

There's been a new emphasis placed on simplifying the guidelines, as many lay rescuers identified "fear of doing something wrong" as a reason for not initiating CPR. There's also been more research suggesting that ventilations are less important in adult cardiac arrest victims, etc.

So now ILCOR / AHA / whoever, has advised chest compression for airway obstructions, and pulse checks have been removed from the sequences. The instructor is teaching you the right (current) material, even if they may not be explaining it in the best manner.
 
mos11b1p said:
n71xi...point made. I am listening. (I make no apologies for being a layperson and coming on this board with honest questions. Ignorance is not a crime. Acting ignorantly most surely can be though. Hey...you dont know if you dont ask and I knew I would get critical feedback and an education if I asked some honest questions here. And despite being lambasted, I would not hesitate to ask OTHER honest questions) Im not interested in being a medical vigilanty. And I certainly did not intend to "minimize" the depth or complexity of the skills of your profession with my word choices, and in so doing, insult.(But your equating proper laryngoscope and forcep use to that of performing back surgery is a stretch...a BIG stretch, even arrogant, no?) I have no interest in playing "Ricky Rescue." Infact, your profession didn't interest me sufficiently to pursue it when i DID complete training. However, life has a way of bringing the situations to you, whether u want them or not. I watched a 19 year-old combat medic do a cric in about 30 seconds under duress...as guess the old latin adage "todo esta facil para el que sabe" applies. ("everything is easy for he who knows.") Fortunately for me, one person actually wrote me a private message and explained WHY it's a bad idea to contemplate the things I've inquired. (For example, who knew you could yank somebody's vocal chords out in an honest effort to dislodge an object? I had no idea.) Perhaps getting formal training and certification for none other than personal knowledge is the right direction after all. Thankyou all for honest and consistant input on my inquirey. Peace.
Click to expand...

I'm sorry, but halfhearted apologies and "what ifs" cut no ice with me. If life has a way of bringing you a situation, you should do what the average, prudent person would do. That is, call 911 and perform any intervention you're trained in. Otherwise, prepare for litigation. And while it may be a stretch to compare the use of a laryngoscope by a layperson to back surgery, it's a shame that your ego wouldn't allow you to make the connection. Perhaps I should have compared the idea of your laryngoscope use to an unlicensed electrician making repairs on your home. I'll spell it out in small words, without a Latin translation. Anyway you slice it, it's a bad idea.

Now, I'm sure the Mods won't like this... but to me, it's worth a vacation.
 
systemet said:
Just to speak to this quickly --- the dangers of performing CPR on someone with a beating heart used to emphasised in CPR courses a few years ago.

However, a lot of research suggested that the even professional rescuers were quite poor at identifying carotid pulses, and that many lay rescuers were withholding CPR on patients who were pulseless because they beleived (in error) that they could feel a pulse.

There's been a new emphasis placed on simplifying the guidelines, as many lay rescuers identified "fear of doing something wrong" as a reason for not initiating CPR. There's also been more research suggesting that ventilations are less important in adult cardiac arrest victims, etc.

So now ILCOR / AHA / whoever, has advised chest compression for airway obstructions, and pulse checks have been removed from the sequences. The instructor is teaching you the right (current) material, even if they may not be explaining it in the best manner.
Click to expand...

Well said.

The idea behind CPR on the unconscious choking patient is:

1. Chest compressions are as good abdominal thrusts or better at creating intrathoracic pressure to dislodge obstructions.

2. Good luck holding someone up to give the traditional Heimlich if they're unconscious.

3. The "back and forth" of chest compressions and bagging can help work the obstruction loose.

4. If they're persistently apneic, even if they had a pulse, eventually they will lose it, at which point you're maintaining circulation AND trying to clear the airway.

5. As noted, CPR-associated injuries should never be weighed as more important than clearing a blocked airway or performing compressions for cardiac arrest. These people are literally dead otherwise.
 
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