In Emergency Medicine “Simplicity” is synonymous of efficiency, efficacy and reproducibility.
More the time frame is stressful more we need procedures that are efficient, efficacious and standardised, in one word SIMPLE.
Critcothyrodotomy and chest drain are procedures usually performed in high stressing scenarios and more simply they are more chance of success they have.
I don’t like complicate kits. They need training of course but even a calm and protected environment, and the middle of a street or a busy ER room aren’t nothing like that.
I don’t like blindly performed procedures but prefer trusting my own senses and sensibility when performing high invasive procedures that, mostly of the times, are a lifesaving last chance.
So this is the best way I know to perform a surgical access to the airway and to drain a highly unstable tense pneumo: using simple instruments, always present in every emergency pack, and trusting my own tactile sensitivity.
In those following videos you can see live records of the procedures. They were captured during a recent cadaver lab where I had the honour to join Jim DuCanto, Yen Chow, Carmine Della Vella and Fabrizio Tarchi in teaching airway management and clinical emergency procedures.
Hope you enjoy.
Le tue opinioni sono il nostro valore aggiunto!
Nice videos
I’d emphasise use of the ‘laryngeal handshake’ to reliably identify the cricothyroid membrane
non-dominant forearm resting on sternum (or forehead, depending on side of approach)
thumb & middle finger either side of broad prominence of laryngx
index finger to identify CTM
KEEP IT THERE!
dominant hand wields scalpel to incise, with non-dmoniant thumb/middle finger either side
i.e. basically keep that non-dominant hand in place
Tx Tim I agree. Identification of CTM is a key step in the whole procedure and standardising the “laryngeal handshake” gave a determinant boost to all the SFB cric manoeuvre. Intuitive easy to teach and reliable. A great starting point in a very stressful situation.