Robert Guillen’s Post

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Firefighter, Paramedic

Went over surgical airway techniques today, focusing specifically on cricothyrotomy. I discussed the indications, contraindications, and the step-by-step procedure, emphasizing the importance of identifying anatomical landmarks such as the cricothyroid membrane. I also covered various methods, including both the needle and surgical approaches, and reviewed potential complications and their management. This comprehensive overview underscored the critical role of cricothyrotomy in emergency airway management, particularly in situations where intubation is not feasible. I do not do this for anyone else. But to start to create habits early into my career so I never become complacent. I will do this by continuously refining my knowledge and skills. I aim to be confident and perform at my best when the time comes.

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Having done 3 in my career and teaching this skill in cadaver lab, my suggestion (because we do not have the numerous encounters like a surgeon) is after making the incision insert hemostats, curved or straight. This will insert while the blade is still in the cricothyroid membrane. Then remove the blade, this way a tool is always in the airway. The hemostats will allow you to dilate the opening to pass a bougie or ETT. It would be very hard to have a finger in the surgical opening and place a tube in simultaneously. Depending on the type trauma this will have a fair amount of bleeding. I did a mvc, shooting and 100% 3/4 degree burn. The burn did not bleed. I like teaching a bougie first to ensure I’m in the airway by obtaining hold up on the carina. Hope this helps. This is a skill we should practice as much as we can to create muscle memory.

Peter Mendlinger

"Knowledge speaks, but wisdom listens." Jimi Hendrix

3mo
Peter Bonadonna

Point of Care Ultrasound Educator / ECG Educator / Paramedic Education

3mo

Nice but voice of experience here…Encourage the 2 cm or 2.5cm initial incision. As you spread the tissue the superior and inferior edges approach each other making the opening even smaller.

art proust

Medical Director at SFVEMSS

3mo

I recommend using a bougie rather than Kelly forcep, ie scalpel -> finger -> bougie -> tube. See Dr. Darren Braude or ITLS current thinking paper

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