If you haven't already, you must watch the Cricothyrotomy Wee
If you want to have any idea what I am talking about…
Here is the comment that sparked this podcast
How to Plan Your Airway
- Take Account of the Whole Situation, both Immediate and Delayed Issues
- Pick the Plan the Fails Best
What is a Bad Option IMrHO?
- Anything through the nose without cutting the wires
What are the Good Options
- Cut the Jaw Wires, Prep for Cric, Perform Awake Fiberoptic Nasal Intubation, then sedate/analgese
- Cut the Jaw Wires, Prep for Cric, Perform RSI, then sedate/analgese
- Perform an Awake Cric
- Perform an Awake Trach
How to Cut Jaw Wires (Arch Bars/Wired Jaw)
There will be 2-5 wires connecting the lugs of the arch bars–you need to cut all of them and retrieve the wires. There may also be elastic that needs to be cut. Medical wire-cutters are best, diagonal cutters also work. In a pinch, any heavy scissors will get through these wires. Then grab them with hemostats and pull them out.
Not many articles in the literature on this topic, but here is one Jones RT et al.
Do Crics Need to Come Out Right Away?
- American Journal of Otolaryngology 2000;121(3):195
- British Journal of Oral and Maxillofacial Surgery 2013;51:779
In appropriate circumstances (prophylactic cricothyroidotomy) has numerous advantages, not least the potential to secure and check the ‘rescue airway’ in a calm and unhurried manner, without hypoxia, before an emergency arises — NAP4 Study
Online Etiquette when Discussing Cases
- Just be nice
- Assume that there were factors you might not understand because you were not there
- Phrase as, “I think if I was in this situation, I would have…”
- If you are going to go nasty, make sure you have the knowledge base to comment (this last one does not pertain to the comment above)
Consent for Filming
- discussed in the podcast
Other Discussions of the Case (For Better or Worse)
Now on to the Podcast…
- EMCrit 277 – COVID Pulmonary Physiology with Martin Tobin - July 9, 2020
- EMCrit 276 – The Rapid Code Status Conversation with Kei Ouchi - June 25, 2020
- EMCrit 275 – NeuroCritical Care with Neha Dangayach - June 10, 2020