Update: Some of the Stuff Here is now Outdated, Come to Podcast 131 for the cric redux
Ok, Ok, I promise this is the last airway episode for at least a little while. I am perhaps a bit obsessed. Had this show in the works for a while. The cric is the last barrier between a failed airway and death. EM docs need to be able to perform this procedure without hesitation. This requires training and practice until you can perform the procedure in < 30 seconds literally with your eyes closed!
On this show:
Since you need to practice and patients get a wee bit pissed if they wake up with an unnecessary, unexpected tube in their neck, you need something to train on. Pig trachs smell and are not great training IMNSHO. Instead, read this article:
Here is the picture
With this set-up, which costs nothing, you can practice as many times as necessary any time you like. You'll see my version of the set-up in my video below.
I prefer surgical crics. I think wire-based seldinger kits fail badly when stress is involved. That is opinion. They are also entirely too slow; that is FACT.
Anaesth Anal 2010;110(4):1083 & Anaesthesia 2006;61:565
Here is a video with the three techniques I prefer for crics
Next we talk to my friend Seth Manoach, another of the ED Intensivist clan. He has a technique for fiberoptic-stylet guided crics.
Last, we talk to Darren Braude of airway911.com fame and author of the book Rapid Sequence Intubation & Rapid Sequence Airway. Darren has a technique for bougie-aided cric that you are going to love.
photo from wikipedia
- 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