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#8 Crash Cricothyrotomy

#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.

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#8 Crash Cricothyrotomy

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  1. #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

  2. Locate Cric Kit

  3. Cric Assessment • Laryngeal Handshake • Ultrasound • SHORT • S: surgery (previous) • H: haematoma(swelling) • O: obesity • R:radiation • T: tumor

  4. 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

  5. Preparation • Can use the “double prep” • Assess, clean, and mark neck

  6. Equipment • Simple Cric Kit • Scalpel • (Bougieon Airway Cart) • 6-0 endotracheal tube(cuffed) • Dressing Pack • Skin Marker • Antiseptic • KY • 10ml syringe • Blue pad • Cook surgical-and percutaneous airway kit

  7. CricTechnique • 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 Cric http://www.youtube.com/watch?v=wVQFJR7qmrQ (7min)

  8. Airway Briefing and checklist • 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/cricif sats <80% • D- Perform open cric • Questions? • Oxygenate the patient!

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