Needle cricothyrotomy

[NYMedic828]

I don't disagree in its readiness, however, selection of the simpler O2-tubing to cannula hub technique is preferred (in my mind) to the syringe + ETT adapter + BVM "trick".

The more human factors deficiencies you remove from the technique the better (for high stress, low practice, low frequency events).

That is basically the idea of the improved means of jet insufflation I was shown. I think we used suction tubing so you can cover the hole when you wanted to let in oxygen or let Co2 out.

How much CO2 really exits the lungs passively though through such a small opening?

 

[NYMedic828]

That is basically the idea of the improved means of jet insufflation I was shown. I think we used suction tubing so you can cover the hole when you wanted to let in oxygen or let Co2 out.

How much CO2 really exits the lungs passively though through such a small opening?

improvised*

 

[Veneficus]

I don't disagree in its readiness, however, selection of the simpler O2-tubing to cannula hub technique is preferred (in my mind) to the syringe + ETT adapter + BVM "trick".

The more human factors deficiencies you remove from the technique the better (for high stress, low practice, low frequency events).

I certainly agree.

 

[Merck]

To answer the question I've done two with the cric set. Percentage-wise however that's running around 0.01% of intubation scenarios so not an often done thing.

I think there is much more to be gained from spending more time teaching adequate BLS techniques such as 2 person BVM, adequate positioning, watching for gastric insufflation +/- Sellick manouever, and proper suctioning. Also improvement to DL technique and training with more live-practice (i.e. with anesthetists), better attention to axes and positioning, high-flow nasal oxygen and pre-oxygenation.

Good training in the common can overcome the need for many emergent airways which may or may not just be iatrogenic.

 

[Veneficus]

That is basically the idea of the improved means of jet insufflation I was shown. I think we used suction tubing so you can cover the hole when you wanted to let in oxygen or let Co2 out.

How much CO2 really exits the lungs passively though through such a small opening?

A better question would be:

"Is relative hypercarbia more beneficial than trying to get the Co2 out?"

 

[NYMedic828]

A better question would be:

"Is relative hypercarbia more beneficial than trying to get the Co2 out?"

Is it?

 

[Veneficus]

Is it?

No idea, that is why it is a question

 

[Merck]

There's no way you're going to ventilate at all with a 14g or something in the neck. A little bit of oxygenation is the best you could hope for. Applying suction will likely just drop the oxygen content of the air in the lungs and perhaps cause proximal airway collapse. Emergency oxygenation is the best you can hope for. If the person is relatively healthy otherwise they can tolerate the hypercapnia for a bit.

 

[mycrofft]

I just performed a needle cric less the 2 weeks ago for a GSW to the neck with a failed airway and ill give you some quick tips so if you have to do it yourself in the field you won't fumble through it.
...
This brings up a very important point. Practice with your equipment, in training I always used a 15mm off of a 3.5ett but when :censored::censored::censored::censored: hit the fan I realized that they no longer worked because we switched vendors on our tubes and wasted a few seconds having to open another tube to grab the adaptor. *


I can not stress enough that this should be practiced regularly in both a skills station setting, and but also in your head so the steps come naturally and without conscious thought should you ever have to actually perform one in an emergent situation

* emphasis mine.
That's one offshoot of the end of the Cold War. NATO milspec greatly influenced uniformity of adapters etc., because if your device needed an adapter, it would not as likely be purchased (versus a device which did NOT need an adapter) in the hundreds of thousands.

Corky, you'r singing my song. Practice like you're going into a gunfight with a new sidearm, don't simulate when you can help it, and USE the materials, don't just LOOK.

 

[mycrofft]

To answer the question I've done two with the cric set. Percentage-wise however that's running around 0.01% of intubation scenarios so not an often done thing.

I think there is much more to be gained from spending more time teaching adequate BLS techniques such as 2 person BVM, adequate positioning, watching for gastric insufflation +/- Sellick manouever, and proper suctioning. Also improvement to DL technique and training with more live-practice (i.e. with anesthetists), better attention to axes and positioning, high-flow nasal oxygen and pre-oxygenation.

Good training in the common can overcome the need for many emergent airways which may or may not just be iatrogenic.

Hear hear. Historically, how many crics have been attempted (and versus how many succeeded) when what was needed was a simple airway, or even a better head-tilt?

And as for needle supplanting incision, I was told that many layperson and other field crics were botched with bad results after the person either went clean out the ventral side of the trachea, and/or slit the thyroid. Sort of like tourniquets in many ways except even less frequently useful.

 

[rennex]

Thanks guys, I appreciate the input.