Podcast 38 - Making The Cut (Landmark Lag)
Making the decision to perform a cricothyrotomy is tough! Now imagine you can't find your landmarks! Here are some tips to help plan, train, and prepare for making the cut.
1. Ditch the needle! Grab a scalpel.
Fine motor skills deteriorate at 115 bpm. This is the time for complex motor skills to be utilized.
2. Expect blood.. don't try to clean it as you go.
Blood is lube and lube is good for passing your tube.
3. Protect your hole.
Until your pass the bougie, protect this hole with your life!
4. Train on real people....using a pen.
Stand alone cric models don't teach you coordination of navigating the patients and and chest. Practice this on people to build your muscle memory. However instead of using a scalpel, use a pen.
5. Watch the angle at which you introduce the bougie.
Car-ram-rodding the bougie at too steep of an angle can leave you deep tissue diving into the posterior aspect of the tracheal tissue. This is one way to bougie the goose even if you are in the trachea (NOT GOOD).
3D Cric Model and EMcrit Tips : https://emcrit.org/racc/wearable-cric-trainer/
Surgical Airway Data: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982374/
Surgical Airway Success In Hostile Environments https://www.ncbi.nlm.nih.gov/pubmed/27273615