So…. I decided to do a session on surgical crics, but focusing on the pre-hospital environment. Let me declare outright that I have never performed a cricothyrotomy in the field. Most paramedics I know have not for their entire careers. It is that unlikely never-event one should be ready to perform. I hope you will find that this presentation helps you in some way.
*Special disclaimer – First read the legal disclaimer at the bottom of every page and in the “about us” page. To be extra clear – Neither I nor anyone involved in producing this claims to be an expert nor do we claim to be doctors, we are paramedics. Always follow the advice and teachings of your medical director rather than random videos you see on the internet.
Now that is not to say I haven’t done a Cric on humans. I was fortunate enough to attend the inaugural AIME Advanced course in Nova Scotia last January.
(see http://admin.aimeairway.ca/userfiles/AIME_Advanced_Poster_Jan_May_2016.pdf for the latest offerings),
I have attended another day of cadaver lab training, and done many sessions using pig tracheas. All of these experiences have helped to shape my opinion on how to do crics correctly.
This following presentation is based on one I made for a best practices meeting a few months ago. In that session, we used pig tracheas with rind draped tightly over it to practice the skill of a surgical cric. What I can tell you is that it has a very realistic tissue feel and this one important part of the training. Just member that a pigs cricothyroid membrane is on the opposite side to humans as they dwell on all fours. For those who do not have access to pigs trachea or the moral inclination not to do procedures on them, try this delicious alternative anyone can practice on … and enjoy thereafter!
Here is that video:
A second part of that training is psychological readiness – being prepared to make that cut when necessary and appreciating that in the state of hyperarousal you will be in when you do it.
As to the former, you need to give yourself permission to make the cut by being crystal clear about when you must do so. As to the latter, you will feel that you will be fumbly, sweaty, and feeling as if you are “not on your game”. This response is due to your natural fight-or-flight response and it is born out of a survival instinct you have very limited control over. My presentation focus on some ways to mitigate this physiological response, but I direct the reader to other great presentations below on the topic in general.
This one is a little controversial but good to think about the mental rehearsal end of things
As usual, questions are always welcome.