1 / 9

#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.

chas
Télécharger la présentation

#8 Crash Cricothyrotomy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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!

More Related