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Thread: Cricothyrotomy Kits

  1. #11
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    Dup............
    Last edited by Hmac; 09-15-17 at 07:12.

  2. #12
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    Sorry guys, I guess I should have added some more qualifiers to the initial question. I can't drop a fly at 1,000 meters with a Barrett-but I do wear scrubs for a living. I'm in my lane here. Certainly cricothyrotomy is a high risk procedure with potential complications. I may be purchasing a bunch of kits and wanted specific recommendations since there have been several new products come to market over the last few years. Application is in-hospital (not field) use. Currently have the Melker and QuickTrach kits, but was seeking the group's expertise with any of the other kits that are out there. I figured that some of you may have developed preferences with various field kits and wanted to tap into that experience. Thanks, and have a good one!

  3. #13
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    Quote Originally Posted by tower59 View Post
    Sorry guys, I guess I should have added some more qualifiers to the initial question. I can't drop a fly at 1,000 meters with a Barrett-but I do wear scrubs for a living. I'm in my lane here. Certainly cricothyrotomy is a high risk procedure with potential complications. I may be purchasing a bunch of kits and wanted specific recommendations since there have been several new products come to market over the last few years. Application is in-hospital (not field) use. Currently have the Melker and QuickTrach kits, but was seeking the group's expertise with any of the other kits that are out there. I figured that some of you may have developed preferences with various field kits and wanted to tap into that experience. Thanks, and have a good one!
    Make your own kit. You probably have access to 5.5 ET tubes? Get a 5.0 or 5.5 (smallest cuffed tubes). Cut down to just above where the fill tube for the balloon/cuff (do not cut the little tube that fills the distal cuff/balloon) comes out the side of the ET tube shortening the tube, as you know you do not need the length for the oropharynx with a trach. Re-attach the adapter that receives the BVM or vent tube into the new shorter ET tube. Keep the tube with a surgical scalpal, some 2x2 and or 4x4 gauze, 18 ga needle, 10cc syringe and a trach hook in an appropriate sterile container or baggy. Perform procedure as you are trained and within your scope and protocols of course. Needle serves as a nice guide after marking the cricothyroid membrane and inserting into the space, scalpal used for vertical incision, using gauze to stabilize trachea midline and absorb blood. Having another set of hands is great. After incision, retain visual and control of the trachea with trach hook. Introduce the tube into the trachea until cuff is below insertion point and above carina. Inflate cuff as you would, confirm placement with auscultation of breath sounds, chest rise, ETCO2, bulb syringe etc. Secure in place as an impaled device with tape and or an ET tube holder if one fits the neck.
    * this is for research and educational purposes only. DO NOT ATTEMPT THIS OUTSIDE YOUR SCOPE OR AN APPROPRIATE FACILITY.
    Last edited by TacMedic556; 09-15-17 at 18:31.

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  4. #14
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    I receive hands on training for the cricothyrotomy once a year. Thankfully, other than performing the procedure many, many times on training models and observing a cadaver demonstration, I have not had to employ it in my practice in 20 years. From the point of view of a guy who may need to employ the technique but has never had to do it, I feel more than comfortable with the QuickTrach. I need it to be simple, since my personal stress levels are likely to be very high. Before I reach for that kit, a lot of things have failed to work. Airway management being a continuum my order of airway management is i.e., head tilt, chin lift, positive pressure bag valve mask with 100% O2, naso and oropharyngeal airways,LMA (laryngeal mask or a King airway), ET intubation and succinylcholine and then my QuickTrach. By then hopefully the paramedics have arrived and I won't have to do it. It seems that I have an easier situation than you as I perform mostly elective surgery under procedural sedation on ASA 1 or 2 with Mal I or II so landmarks are pretty straight forward. Not your typical thread on this board.

  5. #15
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    Our kits were home-brewed: a cut # 7 ETT, a trach hook, a 11 blade, and a Trousseau dilator (spreaders), taken to the local hospital to be steri-packed. Total cost, about $30. That was...1991. Now there are so many options, and of the manufactured kits, I like NARP.

    I have done three. Two patients died. In every single case I about crapped myself.

  6. #16
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    When a crich is in the picture, even in-hospital, it is going to be a $hit-show. I don't do airway management regularly but I have done one. In this instance I used an #11 blade, a snap, and a Ciaglia Blue Rhino perc trach kit. This was what was on hand.

    I would highly recommend having a trach hook, and this is a necessity if the pt's airway is not extremely anterior. You have to be prepared for, and be ready to work through, significant bleeding. Unless you are a highly experienced paramedic, ER MD, or surgeon it can be terrifying (I am the latter).

    The kit I used was mechanistically similar to the H&H kit.

  7. #17
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    I've done a couple of crics over the years. They were always exciting, but certainly not excessively dramatic as they took place where the nurses attending were competent and the appropriate equipment was readily at hand - once in the ER and once in the OR. Both were attempted firearm suicides...one a 9mm pistol and the other a shotgun (THAT was a mess). OTOH, I've done at least a few needle cricothyrotomies with retrograde wire passage and other such convoluted airway manipulations. Our anesthesia people are very skilled. If they need me to secure an airway, that patient is indeed in deep yogurt. I'm sure it would be very exciting in a pre-hospital setting. Hopefully I'll never have to worry about that.

  8. #18
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    Quote Originally Posted by Hmac View Post
    I've done a couple of crics over the years. They were always exciting, but certainly not excessively dramatic as they took place where the nurses attending were competent and the appropriate equipment was readily at hand - once in the ER and once in the OR. Both were attempted firearm suicides...one a 9mm pistol and the other a shotgun (THAT was a mess). OTOH, I've done at least a few needle cricothyrotomies with retrograde wire passage and other such convoluted airway manipulations. Our anesthesia people are very skilled. If they need me to secure an airway, that patient is indeed in deep yogurt. I'm sure it would be very exciting in a pre-hospital setting. Hopefully I'll never have to worry about that.
    A self-inflicted shotgun to the face was one of mine. Bloody mess, no anatomy.

  9. #19
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    The possibility of having to do a cricothyrotomy in a field setting is virtually the only reason I carry a knife in my pocket and keep it sharp. Well...that and opening boxes from Amazon. That knife and maybe a couple of band-aids represent my version of an "IFAK".

  10. #20
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    There are several types of kits available- the traditional surgical approach (scalpel and a breathing tube), needle + Seldinger technique kits, and some newer kits (like the QuickTrach) that have a device that goes directly into the airway. The classic surgical approach is usually a bloody mess, and so one of the possible advantages of the percutaneous kits is purportedly less bleeding. I've never seen a study that was able to actually compare the bleeding rates between the devices in humans, though. (Kind of hard to get people to sign up to do that research!) That's one of the reasons I was hoping to hear from any folks with first hand experience with the new kits. Virtually all the research on this procedure and comparing kits is mannikin or non-living airway model.

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