My friend and former resident, performs a life-saving cricothyrotomy on a post-arrest patient.
Filmed by Reuben Strayer, MD and used with patient consent.
For more on Surgical Airway, come to the EMCrit Cricothyrotomy Page
Article on Arch-Bar Separation
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Scott Weingart
An ED Intensivist from NY. No conflicts of interest (coi).
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Any thought of Nasal Tracheal Intubation in this case?
I would not think nasotracheal is a great way to go in this patient as epistaxis would be a disaster. That would apply to fiberoptic and blind NT.
Thanks to all involved – especially the patient – for a great educational resource.
Hats off,
Chris
Great job with this! This is by far the best video of a real cricothyrotomy I have seen. Paramedics in NH will begin utilizing the bougie assisted surgical cricothyrotomy this year.
Andrew Merelman, Critical Care Paramedic, Exeter Hospital
Kudos!
That others may learn, so that others may live.
This video will save lives
Thank you for a great and timely post with insightful commentary. Thanks also to Ram Parekh and Reuben Strayer (and the patient) for making this available.
This case not only makes for great teaching and discussion but it really exemplifies the power of #FOAMed.
As a critical care fellow, many of us will graduate without having performed this procedure and many consultants can go through their careers not having performed one, and hence not being able to comment on it from first-hand experience.
I saw Scott’s talk on this topic from SMACC, followed it by reading around the topic and discussing with surgeons and anesthetists at our center, followed by a degree of mental preparation in case it comes up. I saw the video emerge on Twitter earlier today and now this great post with comments.
My self (and I am sure many others) are beneficiaries of this great teaching case about such an important and life-saving procedure that any ED physician and intensivist should be able to perform – if this doesn’t exemplify the power of #FOAMed then I don’t know what does. Kudos indeed!
I am closing comments on this post as there have been many comments from Monday morning QBs. To respond to most of these comments:
1. NT is a bad idea in a patient with a wired jaw in a non-elective situation. If he starts bleeding, it is a bad scene.
2. This patient is meta-stable, not stable. This was emergent airway management. The patient had already had multiple codes and was having runs of v. tach while the procedure was performed. This was the most rapid and appropriate means of controlling the airway.
3. The NAP4 study is worth a read for those that don’t believe a cric should be done until you are well down the path of airway disaster.
4. There was a question about the aerosoliized blood being from the NIPPV–I have gotten this spray with all crics.
5. Yes, they could have cut the jaw wires and tried oral. This adds task complexity and may still be difficult airway and then the pt would have required RSI. Awake cric in this patient with perfect anatomy is probably the ideal way to go.
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