#8 Crash Cricothyrotomy
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Transcript of #8 Crash Cricothyrotomy
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#8 Crash Cricothyrotomy• Learning Objectives
– Review• Prep
team/plan/room/equipment• Discuss Difficult Airway
Algorithm• Describe a “Crash Airway”• Declare: Can’t Intubate, Can’t
Oxygenate!– Surgical Cric• Locate equipment• Double Setup• Proper technique
– Scalpel– Bougie– Tube
• Indications
• R40: 40 y/o M swollen tongue, difficulty breathing– Hx angioedema – Obtunded, GCS 6, SaO2 80%
• On Arrival– Sitting Up, Nasal O2, rebreather 02
>15lpm– SaO2 75% and GCS 5– LEMON
• Protruding tongue, Swollen face, 0-3-2, stridor
– Consultant suggests Crash Cric• Declare: Can’t Intubate, Can’t
Oxygenate– Skip Checklist
• +/- sedation/paralysis • Difficult Airway Call (888)• Crash Cricothyrotomy
– End scenario after tube confirmation
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Locate Cric Kit
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Cric Assessment• Laryngeal Handshake
• Ultrasound
• SHORT•S: surgery (previous)•H: haematoma (swelling)•O: obesity•R: radiation•T: tumor
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Indications• Cant intubate, can’t oxygenate
(CICO).• When an experienced clinician
thinks it will be safer than intubation from the top.– Continue to attempt to ventilate
from the top with an LMA/BVM• Age cut-offs?
– APLS suggests <12y/o– Some say <6y/o– Others say <3y/o – AKA: it depends
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Preparation• Can use the “double prep”– Assess, clean, and mark neck
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Equipment• Simple Cric Kit– Scalpel– (Bougie on Airway Cart)– 6-0 endotracheal tube (cuffed)
– Dressing Pack• Skin Marker• Antiseptic• KY• 10ml syringe • Blue pad
• Cook surgical-and percutaneous airway kit
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Cric Technique
• Scalpel-Bougie-Tube • Optimize patient • Oxygenate with BVM/LMA• Locate cricothyroid membrane• Vertical cut skin• Horizontal cut membrane • Bougie• 6-0 ETT over bougie until cuff enters• Confirm and ventilate
Bougie Crichttp://www.youtube.com/watch?v=wVQFJR7qmrQ (7min)
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•We have prepared a “double setup”
•We are are ready for an emergent cricothyrotomy
•We can not intubate and we can not oxygenate.
•Declare an 888 airway emergency
• Our plan is:•A- Attempt direct/bougie/tube•B- Oxygenate with #5 I-LMA•C- Perform scalpel/bougie/cric if sats <80%•D- Perform open cric
• Questions?
• Oxygenate the patient!
Airway Briefing and checklist