I was wondering what the protocol is to manage crikes after the patient gets placed in the ICU.My guess is that they usually replace it with a tracheostomy?And do they put it on the same spot?And in the case that a tracheostomy is not needed, what is done to the trachea to seal the cut?
What happens to a cricothyrotomy in the ICU?
- Thread starter Norbi
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I don't know the full protocol for longer term cricothyrotomy management, but it is a temporizing measure. A tracheotomy is not performed at the same place as a cricothyrotomy. Crikes are performed through the cricothyroid membrane, while trachs are placed more proximally. I'd imagine if a cricothyrotomy has been performed prior to the tracheotomy, they'd simply apply a dressing (maybe stitch it shut) and move on. Since the new trach placement will bypass the upper airway and the crike site altogether, it probably isn't too important.
**Please note, this is pure conjecture.
**Please note, this is pure conjecture.
mycrofft
Still crazy but elsewhere
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When i nursing school/postop unit I tended a post-cryc. They sutured it shut and it healed.
Traches are lower . Look it up on wikipedia.
Traches are lower . Look it up on wikipedia.
VFlutter
Flight Nurse
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The CCP/Pulm/MDA would likely attempt to intubate using various techniques, maybe a retrograde intubation via the cric, if possible. If the patient is expected to be intubated long term, 5+ days, or can not be intubated then they will just do a trachestomy. The cric site would be sutured or wound glued.
*Disclamer: I have not seen a cric patient in the unit yet. It rarely happens. We trach and the bedside if needed. The only way we would see them is if the flight crew does it en route.
*Disclamer: I have not seen a cric patient in the unit yet. It rarely happens. We trach and the bedside if needed. The only way we would see them is if the flight crew does it en route.
Depending on the situation, they'd probably determine if the patient is expected to remain intubated for an extended period of time. If they are expected to remain tubed, then they'd probably convert to a trach and suture the cric shut. I suppose the question I'd have is do they try to suture the cricothyroid membrane or just close the overlying tissue.
But, as mentioned, trach's are performed more proximally, so the cric shouldn't interfere with placement.
But, as mentioned, trach's are performed more proximally, so the cric shouldn't interfere with placement.
Yes I was wondering the same thing about suturing membrane and the incision on the trachea itself.Maybe the trachea gets left alone?It seem like a rigid enough structure to keep itself in place...but then again, that sounds pretty negligent.Also, if the pt gets machine ventilated, then there's a good chance of pneumonia,tracheitis etc. in which case sealing the hole would maybe be a good idea.Thanks for the replies everyone.
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I have been told that the CTM closes itself very well and very quickly, that the only thing that needs to be done is to close the skin.