Needle or the Knife for the Cricothyrotomy
In this episode, I debate Minh Le Cong, a retrieval physician from Australia. The question is what technique should we use in the can't intubate/can't oxygenate (CICO) situation.
Throughout the podcast, you will hear reference to Dr. Andrew Heard, who has written some fantastic papers on the subject. Perhaps most pertinent is his description of the formation of a CICO protocol based on his experience with a wet sheep airway instruction lab.
Heard AM, Green RJ, Eakins P. The formulation and introduction of a ‘can't intubate, can't ventilate' algorithm into clinical practice. Anaesthesia. 2009 Jun;64(6):601-8.
Here is the algorithm from the paper (Click for full size)
Here is his video on the cannula cricothyrotomy technique
Here is his video on the scalpel-finger-cannula technique
Here is a video describing why Dr. Heard prefers the 14G Insyte Catheter for Needle Cric
Here is his preferred method for oxygenation through the cannula
And here is the jet ventilation video:
The paper on the use of ultrasound to find the cricothyroid membrane is quite interesting.
One of the best things Minh expressed is the need to say OUT LOUD: “This is a can't intubate/can't oxygenate situation.” Saying it out loud lets everyone in the room know, there will be no more screwing around with attempts at direct laryngoscopy.
Go to the Broome Docs Blog for more Minh Le Cong.
He is an incredible guy, expect to hear more from Minh on the podcast.
I also gave a shout-out to a new podcast, the Emergency Ultrasound Podcast.
and now the EMCrit Podcast 53…
- COVID19 – Awake Pronation (aka the Pig Roast) A guest write-up by David Gordon, MD - April 6, 2020
- EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients - April 4, 2020
- EMCrit 269 – Rationing of Critical Care and Ventilators in COVID19 with Reub Strayer - March 31, 2020