#8 Crash Cricothyrotomy Learning Objectives – Review Prep team/plan/room/equipment Discuss...
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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 O 2 , rebreather 0 2 >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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Transcript of #8 Crash Cricothyrotomy Learning Objectives – Review Prep team/plan/room/equipment Discuss...
#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
Locate Cric Kit
Cric Assessment• Laryngeal Handshake
• Ultrasound
• SHORT•S: surgery (previous)
•H: haematoma (swelling)
•O: obesity•R: radiation•T: tumor
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
Preparation• Can use the “double prep”– Assess, clean, and mark neck
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
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)
•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
