Cricothyrotomy revisited

triemal04 said:
One more time, and very slowly.

There is a difference between CAUSING a death, and FAILING TO PREVENT a death.YES. Or we'd all be murderers many times over.

If a patient does not have a patent airway, for instance due to severe trauma, and is unable to ventilate themself, they are going to die. The CAUSE of death would be the lack of ventilation. If attempts at placing an advanced airway fail, a BVM is ineffective, and a crich is ineffective, those did not CAUSE the death, they FAILED TO PREVENT IT. IF the cric was done right, but it was still ineffective, then it didn't. If it sliced a major vessel etc then it DID. See below).

This does not mean that there is no accountability, or that FAILING TO PREVENT a death means that everything was done right, it just means that the CAUSE of death was not the procedure. No idea where accountability became an issue other than as an understandable logical extension, but I agree.

If you refuse to understand that then it's the end of the conversation. See last part.
Click to expand...

Ah, the conversation continues. Not to worry. Part and parcel of EMTLIFE. ;)

I understand you. They key is whether the procedure caused the death.

Not that it was ineffective, I entirely agree. As in it was too late or it was ineffective. It can still be the right thing to do, but it just didn't or couldn't work. A futile but not lethal attempt of the right thing is not an iatrogenic death.

But if I have a pt asphyxiating and thrashing and my 10 blade slips and severs a jugular, it is an accidental iatrogenic death. Iatrogenic doesn't mean it was the wrong thing to do, it just means that what was done in a particular instance was the proximal cause of expiration. Not my fault, it was the pt's last chance, I did everything right, but the pt sunfished on me and the blade went kiddywankers. Medical examiner will write in cause of death is exsanguination but will also note pt was moribund due to airway embarrassment.

Part and parcel of the old concepts of "until you've killed someone you aren't a real surgeon" and "playing for points" (continuing care despite it being futile).

Robb's initial response was "unless it is improperly performed it is not iatrogenic" or words to that immediate effect, and that is dead on (I mean, correct).

Good, bad, wrong, right, if it is what crossed the "finished" line first, it's the cause of death. In fact you could do something lethal (say, jumping up and down on the pt'/s chest after a drowning) but if the pt died first then it was not iatrogenic. Just really embarrassing.

Not intended to make anyone upset, it is splitting hairs, unless/until the trends start firming up. (Like laypersons misusing tourniquets led to TK's being banned from laypersons training for so many years). If you start seeing clusters or a creeping rising tide of such, then something needs a closer look.

Thanks for your patience and I hope this doesn't negatively affect your enjoyment of the website.

[There is one silver lining to this paradigm. If you do everything right, or you at least do everything possible that you could, and somehow it seemingly results in the pt expiring (or doesn't, might need an autopsy to tell) then you need to take it easier on yourself than some people will be wont to do].
 
Okay. I respect that.
 
Ok ya if tweedle dee paramedic knicks a major vessel and they die of blood loss then fine, call it iatrogenic if you want to. Outside of that or a failed crich that wasn't indicated that results in a death I see no way for you to call these deaths iatrogenic.

You're very difficult to understand.
 
No matter how close to the patient's inevitable expiration the act is performed, if an act performed in the course of medical care is the proximal cause of expiration, it is iatrogenic.

Iatrogenic=harmful or non-curative results of medical treatment. Many things are iatrogenic and harmless (upset stomach from antibiotics, simple scars from surgery). It describes the point of origin, it is not in and of itself a value judgement (although in the case of a death there is some 'splaining to do).

Therefore even if the cric is the patient's last chance to live, if the attempt to perform it creates a lethal wound, no matter how necessary the attempt was, then the death, no matter how inevitable, is iatrogenic; the pt died of exsanguination when he was originally dying of asphyxiation.

Hence my phrase, "Snatching defeat from the jaws of defeat".
 
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I have only done them on human cadavers and pigs, however... if you do it properly I think the possibility of hitting a major vessel is low, unless your like freaking Freddy Krueger or Edward Scissor hands up in there.
 
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Choice of instruments

edward_scissorhands.jpg
 
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