Backup airways: which to keep in the ALS bag?

[Paradude]

Sure, but a surgical cric will give the patient a secure, sealed and positive pressure airway. No aspiration, and minimal scarring if done correctly. If you have a kit, and the correct procedure, it can be done in under 20 seconds.

We use actually the fastest, and the cheapest method.

We use a #11 scalpel, and stand on the patients right side if you are right handed, or left side if you are left handed.

After donning your sterile gloves (right!) and disinfecting the incision site (right!), we stretch the skin taught over the larynx with the left thumb and forefinger, and note the prominences of the criciod cartilage and the thyroid cartilage.

We then make sure to keep the fingers of the left hand in the same place so as not to lose the relative position of those landmarks, and make about a 3cm incision starting from the bony prominince of the cricoid cartilage to the bony prominence of the thyroid cartilage.

With the fingers of the left hand now holding the incision open, we then take the scalpel and make a horizontal incision across the cricthyroid membrane.

We then turn the scalpel over, and insert the handle into the incision of the cricothyroid membrane, and then turn it 90 degrees.

Keeping the scalpel handle in place, we insert a 6.5 ET tube that has been cut off right above the stem, and insert it along the scalpel handle toward the sternal notch.

We then inflate the cuff, and confirm placement.

We then have a stack of about 20 4x4's that have been cut down the to the middle and take half and put one way across the incision, and the other half the other way.

Then we tape it down.

From first incision to airway, is only about 15 seconds or so.

Other methods were researched, but considering this way was the fastest and easiest, we went with that. It sounds complicated, but I was trying to explain it in as much detail as possible. If you go through the motions in your mind, I think you'll see it is pretty quick and easy.

-Paradude

[chbare]

Well, if it works for your service and you medical direction advocates this approach, I cannot say much.

A few points to ponder:

-A rescue device will establish an airway in a similar time frame without having to cut skin.

-Even performed properly, a surgical airway is not without risk.

-Having additional backups only provides you with additional tools and advantages.

We utilize the 4 step approach to surgical airways at my service. I have yet to perform a cric in my year and some odd months of flying. I have assisted in performing 1 cric in the 5 years ER experience I had. However, I have seen rescue airways used with success several times.

Take care,

chbare.

[tniuqs]

Sure, but a surgical cric will give the patient a secure, sealed and positive pressure airway. No aspiration, and minimal scarring if done correctly. If you have a kit, and the correct procedure, it can be done in under 20 seconds.

-Paradude

A very good teaching post, I must agree the idea of doing a surgical trach is definative and provides for superior airway when compared to all of the above, "adjuncts" a no nonsence positive aproach.

This has always been the option available for myself but I have only ever needed to go this route on one occassion (on a small 14 y/o male with facial smash) in over 20 years as a para, this incudes 14 or so years in the air. Have used the EOA x 12 times in the dark ages before legislation ALLOWED us to "Tube" so going backward's is hard to swallow...no pun intended.

In the MICU the bronch is the route to go, but that is huge pesos.

cheers

[Paradude]

I have also heard alot about the Melker system. It seems to be slower, much more expensive, and does not give as secure an airway.

-Paradude-

[scottymedic]

As it is with the moment (and I am actually waiting to still see my first one up close) Combitubes don't exist in New Zealand. LMA has been dropped to intermediate level care here, they are easy to insert and when the time calls for something a bit more than an OPA or NPA, then an LMA is a good alternative (whilst please remembering that Combitubes are NOT used here in NZ).

Has there been much success or use preshospitally with intubating LMA's? We have them in ICU and ED, just curious about them preshospitally.

Scotty

[ksmedic202]

When I was in internship, the LMA was referred to as the "Last Medical Adjunct". It was not thought highly of in the prehospital setting. It now seems to be gaining popularity. I don't know much about them, all the services I have worked for don't use them. The county service I work for carries the the old EOA's and a surgical crich kit with protocol similar to the one mentioned earlier. The other service I work for carries the combi-tube and a large bore needle crich kit. We looked at the King tube awhile back but have not made a decision yet. I guess what I am trying to say is for my service, its the combi-tube

[Spock]

I've been using the King in the OR for over 18 months as a primary airway and feel it is much better than the LMA or combitube. My EMS agency switched to the King from the combitube as a rescue device in April. It has been used 6 times since then with good results. Unfortunately that also means we have a bunch of medics that can't intubate.

Look at the King closely and I think you will like it. I didn't know the EOA still existed.

Live long and prosper.

Spock

[Medic26]

We carry the king and combitube both......we haven't used the King since getting them about 8 months ago. We also carry the gum boujie too, but to my knowledge we haven't used any of them in about a year of having them. There are alot of good devices out there to look at but if the King is as good as we have been told.....it will eliminate our combitubes being carried.

[tniuqs]

I've been using the King in the OR for over 18 months as a primary airway and feel it is much better than the LMA or combitube. My EMS agency switched to the King from the combitube as a rescue device in April. It has been used 6 times since then with good results. Unfortunately that also means we have a bunch of medics that can't intubate.

Look at the King closely and I think you will like it. I didn't know the EOA still existed.

Live long and prosper.

Spock

Yes Spock you bring up a very good point, the introduction of tecknology vs addressing the real issue, practice and ongoing cometency in ETT. Why are we not addressing the issue of Education as opposed to a quick fix as identified by AHF ?

[tniuqs]

Or education in regards to poor spelling..... :oops: