Research and Reviews in the Fastlane 093

This study of 50 volunteers suggests that three commonly taught methods for finding the cricothyroid membrane (general palpation, four-finger, skin crease) are relatively inaccurate, using ultrasonography as the gold standard. I conclude:1. The landmark techniques are inaccurate for finding the CTM *and that’s okay.* Make your best guess using general palpation and if you feel nothing, use four-finger or skin crease **and then make a long vertical incision.** Once you get through the skin you are very likely to be able to feel the CTM, and even if you still can’t at that point, that’s fine too, cut to air.2. If you have time to prepare (e.g. prior to RSI in a patient predicted to be very difficult laryngoscopy) put the ultrasound probe on the neck and mark the CTM.

Recommended by Lauren Westafer, Reuben Strayer

The Best of the Rest
Emergency MedicineSchechter MT, Sheps SB. Diagnostic testing revisited: pathways through uncertainty. Can Med Assoc J 1985;132(7):755-60. PMID: 3884119

The authors in this review, describe 4 principles clinicians can use and teach to stop the epidemic of over testing which beleaguers healthcare. Did I mention this was published in 1985? The principles are

In the diagnostic context, patients do not have a disease, only a probability of disease.
Diagnostic tests are merely revisions of probability.
Test interpretation should precede test ordering.
In general, if the revisions in probabilities caused by a diagnostic test ...

Source: Life in the Fast Lane - July 29, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Education Emergency Medicine Intensive Care R&R in the FASTLANE Trauma critical care EBM literature recommendations research and reviews Source Type: blogs